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/  W  J 


OF    TH  E 

•School  oj^ Medicine 


\ 


THE  HOSPITAL  BULLETIN 


OF   THE 

UNIVERSITY  OF  MARYLAND 


%^ 


VOL.  VIII. 


MARCH  IS,   1912. 


* 


No.   1 


CONTENTS 


ORIGINAL  ARTICLES— 

The  Public  Should  Be  Educated  in  Regard  to 
Cancer  the  Same  as  Is  Being'  Done  in 
Tuberculosis.     A.  Aldridge  Matthews,  M.I). 

Is  Syphilis  Hereditary?    E.  K.  Tullidge 

An  Analytical  Study  of  Fifty  Cases  Treated 
in  the  Gastro-Enterological  Department  of 
the  University  of  Maryland.  Reviewed 
with  special  attention  to  the  Anthropomet- 
ric Measurements.  Albert  Hynson  Carroll. 
M.D..  and  Edward  A.  Loper  and  Edward 
P.  Kolb,  Class  of  1912 


The  Symptomatology  of  Typhoid  Fever  and 
Its  Complications.  C.  W.  Rauschenbach, 
Senior  Medical  Student 10 

1            EDITORIALS 13 

4  Retrospect  and  Prospect. 

Second  Call  for  Dinner. 

ITEMS    15 

UNDERGRADUATE   NOTES iS 

BIRTHS    19 

MARRIAGES   19 

7           DEATHS   19 


111 


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For      V/' 
AMENORRHEA  v 

DYSMENORRHEA 
MENORRHAGIA 

METRORRHAGIA 
ETC. 


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Ki: 


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\DOSE :  One  to  two  capsules  three 
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THE  HOSPITAL  BULLETIN 

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Vol.   VIII 


BALTIMORE,  MD.,  MARCH  IS,   1912. 


No.  1 


THE  PUBLIC  SHOULD  BE  EDUCATED 
IX  REGARD  TO  CANCER  THE  SAME 
AS  IS  BEING  DONE  IN  TUBERCU- 
LOSIS. 


By  A.  Aldkidge  Matthews.  M.D. 


Cancer  is  almost  the  only  disease  which  is  on 
the  increase  in  the  civilized  world.  'Whether  this 
is  a  true  increase  or  whether  it  is  due  to  the  pro- 
fession recognizing  the  disease  more  accurately, 
and  the  statistics  being  better  kept  by  the  profes- 
sion, by  institutions  and  by  the  Government,  1 
canm  it  say,  but  I  am  inclined  to  think  it  is  the 
latter:  but  nevertheless  we  have  to  admit  there  is 
a  decided  increase  of  cancer  mortality  in  the  rec- 
ords of  today  over  former  ones. 

This  world-wide  disease  is  not  confined  to  any 
certain  people,  but  occurs  among  all  races  of  man- 
kind, and  is  indeed  found  throughout  the  verte- 
brate kingdom.  Domestic  animals  are  more  sus- 
ceptible to  it  than  animals  in  the  wild  state.  Dr. 
C.  W.  Mayo  explains  this  fact  as  being  due  to 
their  longer  life,  the  disease  being  more  common 
in  the  relatively  aged  in  both  man  and  animal. 

The  medical  profession,  with  the  aid  of  the 
press,  the  National  Government  and  the  anti- 
culosis  societies,  have  put  on  foot  a  crusade 
against  tuberculosis,  and  it  is  being  brought 
forcefully  to  the  laity,  who  are  taking  an  active 
part  in  causing  a  universal  reduction  in  tubercu- 
losis. The  public  must  be  educated  along  these 
line: — that  cancer  is  a  local  disease  in  its  incip- 
iencv.  and  is  curable  when  properly  cared  for  in 
the  majority  of  cases:  until  this  is  done  we  can- 
not hope  t'i  reduce  the  cancer  mortality.  If 
the  laity  were  properly  informed  in  regard  to  this, 
mid  make  it  much  easier  and  more  satisfac- 
tory to  reduce  and  keep  down  the  mortalit)  of  this 
dreaded  disease,  and  this  education  must  come 
through  the  physician,  directly  and  indirectly;  so 
the  sooner  it  is  begun,  the  sooner  we  may  expect 
results. 


There  are  precancerous  conditions  which,  if 
taken  bold  of  when  such,  would  prevent  cancer 
formation.  Most  cancer  deaths  are  due  to  delay, 
and  are  therefore  unnecessary.  The  first  or  cur- 
able stage  has  been  ignored,  and  cure  has  been 
sought  only  when  the  disease  has  become  incur- 
able. This  delay  is  not  always  due  to  the  patient 
himself,  but  often  to  his  physician,  either  directly 
or  by  advising  him  to  wait  and  see  what  the  fu- 
ture will  develop,  or  by  temporizing  with  some 
placebo  which  he  knows  is  valueless,  but  which 
the  patient  ignorantly  supposes  to  be  curative. 

As  Greenou.Ldi  has  said  (  referring  to  benign 
breast  tumors  I,  no  tumor  is  innocent  and  incapa- 
ble of  harm  until  removed. 

Childe  of  Portsmouth,  England,  more  than  any 
other  English  or  American  writer,  has  emphasized 
the  true  importance  of  the  early  signs  of  cancer. 
I  le  calls  them  danger  signals,  and  compares  them 
with  the  danger  signals  in  other  conditions.  Dan- 
ger signals  in  cancer,  just  as  on  the  railroad  or  at 
sea,  mean  that  there  must  lie  immediate  and  effi- 
cient action  in  order  to  prevent  disaster.  The 
physician  who  neglects  the  danger  signal  in  a  can- 
cer patient  is  just  as  much  responsible  for  the 
disaster  to  his  patient  as  the  engineer  is  to  his 
passenger  if  he  neglects  the  danger  signal  and 
runs  into  an  open  switch.  Cliilde's  danger  signals 
are  briefly  as  fi  illi  iws  : 

T.  Cancer  of  the  breast.  I  fere  the  danger  sig- 
nal is  a  small  lump  or  thickening  of  any  kind.  In 
a  woman  over  35  years  old  this  lump  is  a  cancer 
from  the  start  in  at  least  go  per  cent,  of  cases.  In 
a  woman  of  any  age  the  finding  of  a  lump  in  the 
breast  should  be  immediately  followed  by  its 
mi  ival. 

2.  Cancer  of  the  uterus.  The  danger  signal 
here  is  an  irregular  bleeding,  especially  after  the 
menopause,  or  the  onset  of  a  discharge  in  a 
woman  who  has  been  free  from  it  previously,  or 
the  change  in  character  of  a  previously  pn 
discharge  SO  that  it  becomes  more  profuse,  more 
foid  or  more  irritating. 


v, 


THE    HOSPITAL    BULLETIN 


3.  Cancer  of  the  lip,  mouth  and  tongue.  The 
danger  signal  here  is  any  sore  that  will  not  heal. 

4.  Cancer  of  the  skin.  The  danger  signal  here 
is  any  sore  that  will  not  promptly  heal,  or  any 
wart  or  mole  which  suddenly  begins  to  grow 
rapidly. 

5.  Cancer  of  the  stomach  and  intestines.  Here 
the  danger  signals  are  not  so  apparent  as  on  the 
surface  of  the  body.  After  40  years  of  age  the 
onset  of  obstinate  indigestion,  persistent  collicky 
pains  in  the  abdomen,  persistent  diarrhea,  and 
especially  vomiting  or  the  passage  of  blood  in  the 
stools,  are  the  danger  signals,  and  their  real  cause 
must  be  determined  at  once. 

It  is  unfortunately  too  true  that  a  large  number 
of  people  notice  these  danger  signals  themselves, 
but  do  not  apply  to  a  physician  until  ample  time 
has  been  given  for  the  incurable  stage  to  develop. 

Quoting  from  Childe  again,  it  is  unfortunate 
that  a  patient  will  run  to  a  dentist  with  a  tooth- 
ache much  more  quickly  than  to  a  physician  on 
account  of  symptoms  pointing  to  a  malady  which, 
if  neglected,  will  prove  fatal.  Many  people  will 
not  bother  with  the  early  warning  symptoms  if 
there  is  no  pain  and  no  impairment  in  general 
health.  The  patient  waits  for  these  to  come  on 
before  they  admit  the  possibility  of  cancer,  and, 
unfortunately,  the  physician  may  countenance  a 
similar  delay.  Yet  there  is  nothing  more  certain 
than  that  pain  and  cachexia  are  never  present  in 
the  early  curable  stages,  but  come  on  only  when 
the  disease  is  hopeless,  the  early  danger  signals 
have  been  neglected  and  help  has  been  asked  only 
on  the  appearance  of  appending  death. 

(  Ine  of  the  most  common  sites  for  cancer  in  the 
female  is  the  breast.  At  a  meeting  of  the  Ameri- 
can Surgical  Association  held  in  May,  1907,  a 
symposium  on  cancer  of  the  breast  showed  the 
percentage  of  cures  following  the  radical  breast 
operation  was  from  20  to  40  per  cent.  i\\  cases 
where  there  was  no  axillary  involvement  at  the 
time  of  operation  the  percentage  has  increased 
from  70  to  80  per  cent.  Eighty  per  cent,  of  tu- 
mors of  the  breast  are  malignant  or  become  so. 

Drs.  Greenough's,  Simmons*  and  Harry's  report 
from  Massachusetts  General  Hospital  show  that 
early  operation  done  and  not  complete  gave  bet- 
ter results  than  a  radical  operation  done  late  or 
after  axillial  involvement,  and  their  total  cures 
were  20  per  cent.  The  conclusion  to  be  drawn 
from  this  is  that  a  radical  opera! ion  should  be 
dime  as  early  as  possible. 


In  England  the  statistics  for  1905  show  that 
cancer  is  more  fatal  to  women  than  tuberculosis, 
there  being  100  deaths  per  100,000  for  the  former 
to  94  for  the  latter.  The  English  statistics  fur- 
ther show  that  while  at  present  more  women  are 
affected  with  cancer  than  men,  the  proportion  of 
males  having  cancer  has  increased  more  rapidly 
since  1850  than  females.  Omitting  carcinoma  of 
the  breast  and  uterus,  the  disease  is  more  common 
in  male  than  in  female.  The  English  statistics 
for  1906  show  that  I  in  11  in  all  men  and  1  in  S 
of  all  women  35  years  of  age  or  more  die  eventu- 
ally of  cancer.  The  statistics  of  the  United  States 
are  not  as  complete  as  those  of  England.  They 
show  deaths  from  malignant  disease  in  1850  were 
9  per  100,000,  while  in  1900  they  had  increased 
to  43,  or  nearly  fivefold  in  50  years. 

The  deaths  from  cancer  alone  in  1890  were  47 
per  100,000,  but  had  increased  to  60  per  100.000 
in  1900.  The  deaths  from  tuberculosis  in  1890 
were  245  per  100,000,  but  had  decreased  to  187 
per  100,000  in  1000.  In  New  York  State,  where 
very  good  statistical  records  are  kept,  these 
showed  an  increased  mortality  in  proportion  to 
the  population  25.4  in  the  10  years  from  1896  to 
1906,  while  the  tuberculosis  ratio  decreased  4.9. 
The  death  proportion  in  the  State  of  Minnesota 
for  the  year  1908  was  1  in  17  from  cancer.  The 
United  States  census  report  for  1900  showed 
that  1  death  in  29  was  due  to  cancer. 

Since  1880  the  comparatively  excellent  figures 
of  the  State  of  Massachusetts  show  an  increase 
from  5.21  to  8.80  for  the  same  period.  Accord- 
ing to  the  Government  mortality 'statistics  of  the 
twelfth  census,  cancer  had  made  a  gain  of  12. 1 
deaths  per  100,000  during  the  past  10  years,  and 
in  1909  cancer  held  ninth  place  as  a  factor  in  the 
cause  of  death.  It  is  further  worth  noticing  that 
cancer  showed  an  increase  in  every  State  except 
Maryland  and  South  Dakota  from  1908  to  1909. 

Kelly  claims  that  the  uterus  is  the  most  fre- 
quent site  of  primary  carcinoma,  although  he 
gives  no  figures  to  prove  his  statement. 
There  are  many  authors  who  disagree  with  him 
on  this  subject.  He  also  states  that  the  fundus  is 
more  likely  to  be  attacked  at  and  after  the  meno- 
pause, while  the  cervix  is  more  susceptible  while 
the  menses  persist. 

Martin  in  "Osier's  System"  states  that  about 
one-half  of  all  cancers  arise  in  the  stomach. 

Reich's  figures  at  Hamburg  (1879  t0  r895  >  dis- 
close that  50.2  per  cent,  of  all  cancers  were  gas- 


THE   HOSPITAL   BULLETIN 


3 


trie,  while  gastro-intestinal  tract  furnished  75  per 
cent,  to  80  per  cent,  of  all  carcinomata.  The 
combined  analysis  of  70.00(1  eases  of  cancer  dem- 
onstrated over  21,000  I  33  per  cent.)  to  be  gastric. 

I  uttle  clan. is  that  So  per  cent,  of  all  cancers  oi 
the  intestines  occur  in  the  rectum. 

We  must  not  forget  that  cancer  occurs  in  early 
life  as  well  as  later.  While  it  is  true  the  vast  ma- 
jority "l'  cancers  occur  in  the  latter  half  of 
life,  it  has  occurred  in  infancy.  Reigle  reported 
■  me  case  of  cancer  of  the  stomach  in  a  child  six 
weeks  .ild. 

In  New  York  there  were  six  deaths  reported 
in  1000  from  cancer  in  children  under  10  years 
of  age. 

According  to  Fisk,  this  increase  is  well  shown 
for  each  age  period  as  indicated  in  the  following 
table  : 

Per  cent. 
\-c.  1880.       1907.  increase. 

Below  20  years 0.19         0.21  10 

20  to  .30  years 0.45         0.36         46 

30  to  40  years 0.2  3.  50 

50  to  60  years 1 1 .8        22.9  94 

Over  60  years 2.4        45.8  90 

The  relation  of  carcinoma  to  sexes  presents  some 
important  facts.  Bland  of  Philadelphia  found 
15,379  cases  of  cancer  ending  fatally  from  1879 
to  1004;  that  the  deaths  among  women  were  twice 
as  numerous  as  those  among  men.  This  was  due 
to  the  great  frequency  of  the  cancer  of  the  uterus 
and  breast. 

Welch  reports  the  proportion  of  gastric  cancers 
being  five  in  men  to  four  in  women. 

Tuttle  claims  that  60  per  cent,  of  rectal  cancers 
are  in  men. 

Wile  of  Xew  York  reporting  from  the  census 
claims  5.5  per  cent,  of  all  deaths  in  the  male  for 
the  year  1909  as  compared  with  5.1  per  cent,  in 
1908.  For  females  8.1  per  cent,  of  all  deaths  as 
compared  with  ~.$  per  cent,  in  190S  were  due  to 
cancer. 

Well  might  the  Registrar-General  of  England 
generalize  by  stating  that  of  women  living  at  the 
age  of  36  years  and  upward  one  out  of  nine  will 
die  of  cancer. 

Templeman  has  called  attention  to  the  fact  that 
cancer  deaths  have  doubled  in  the  past  25  years, 
going  from  7.27  in  10,000  of  population  to  [6.9a 
in  10,000  population  over  20  years  of  age. 

I   think  possibly   the  best   definition  of  cancer 


has  been  given  by  L.  S.  Pilcher,  who  describes  it 
as  follows : 

"It  is  a  lawless  proliferation  of  the  pre-existing 
epithelial  cells  in  luxuriant,  irregular-arranged 
masses  that  invade  underlying  and  surrounding 
tissue  primarily,  destroying  them  and  finally 
themselves,  attaining  a  mass  that  can  no  longer 
be  adequately  nourished  by  an  accessible  blood 
supply,  and  which  itself  then  falls  into  central 
decay,  while  at  the  periphery  the  process  still 
goes  on." 

These  growths  closely  resemble  the  embryonic 
development  of  cells  in  the  power  of  cell  multi- 
plication and  in  the  continuance  of  type  in  the 
metastasis  and  transplantation  of  the  growth. 

It  is  generally  supposed  that  a  carcinoma  often 
develops  from  severe  injury,  but  there  is  no  evi- 
dence that  single  injury  does  any  more  than  call 
attention  for  the  first  time  to  a  pre-existing  tumor 
or  hasten  the  growth  of  an  early  malignancy. 
Trauma  as  a  cause  has  not  been  established  by 
any  of  our  statistics.  Dr.  C.  W.  Mayo  says  it  is 
an  apparent  fact  that  in  classifying  the  causes 
which  may  render  precancerous  conditions  active 
we  should  include  nerve  fatigue,  such  as  is  seen 
in  the  modern  business  world.  The  organs  of 
convenience,  i.  <\.  stomach,  bladder  and  large 
bowel,  which  were  added  late  to  primitive  life, 
have  poor  cell  resistance  and  are  prone  to  cancer 
degeneration. 

It  is  a  well-recognized  fact  that  cancer  often 
develops  from  chronic  irritation,  such  as  epitheli- 
oma of  the  lip,  from  irritations  caused  by  the  pipe 
stem  in  inveterate  smokers,  or  by  a  jagged  tooth  ; 
or  fibromyomata  of  the  uterus  and  breast, 
ulcer  of  stomach  and  bowel  diverticulitis,  and 
many  other  conditions  of  such  character.  Mac- 
Carry  of  Rochester  has  found  in  a  study  of 
5000  appendices  which  had  been  removed  for 
chronic  subacute  appendicitis  that  0.5  per  cent. 
of  these  were  carcinomatous,  and  the  diagnosis 
of  23  per  cent,  of  these  was  not  suspected  at  the 
time  of  removal,  but  detected  later  in  the  lab.  ra 
t.  iry. 

I  have  said  nothing  as  to  the  etiology,  because  I 
have  nothing  new  to  say. 

The  occurrence  of  the  majority  of  cancers  after 
30  years  of  age  is  rather  against  Cohnheim's  the- 
ory of  cell  inclusion.  The  effect  of  dietary  indis 
cretions  is  suggestive  in  the  fact  that  over  40  per 
cent,  of  all  cancers  are  localized  in  the  alimentary 
tract.     This  is  no  more  conclusive  than  asserting 


THE    HOSPITAL    BULLETIN 


trauma  as  a  factor  because  over  20  per  cent,  are 
mammary  or  uterine. 

Heredity  I  do  not  think  plays  any  important 
pari  or  has  any  bearing  on  the  etiology. 

The  present  search  for  the  parasitic  origin  of 
the  disease  has  received  but  little  encouragement. 
Whether  the  present  era  of  animal  experiments 
will  link  carcinoma  to  tuberculosis  in  some  way, 
as  the  recent  experiments  of  Dickson,  Smith  and 
Fox  have  suggested,  or  whether  the  disease  may 
he  transmitted  through  the  agency  of  some  yet 
undiscovered  parasite,  statistics  give  no  testi- 
mony. 'We  should  not  give  up  this  idea  entirely, 
for  practically  all  of  our  acute  diseases  with  which 
the  people  of  our  universe  are  affected  are  due  to 
bacterial  infection,  and  therefore  we  should  con- 
tinue to  search  diligently  for  the  germ  of  cancer 
so  that  an  antagonistic  remedy  may  be  developed 
for  its  cure. 

We  cannot  hope  to  cure  cancer  with  our  pres- 
ent knowledge  of  its  cause.  The  most  optimistic 
internist  cannot  claim  a  single  cure.  Serum  ther- 
apy has  revolutionized  the  treatment  of  many 
diseases,  but  has  been  of  no  help  in  cancer. 
The  X-ray,  which  at  first  promised  so  much,  is 
now  regarded  as  of  little  value  except  in  the  most 
superficial  skin  cancers.  The  treatment  of  cancer 
by  radium  is  in  the  experimental  stage. 

The  question  has  been  asked  me  a  number  of 
times  why  cancer  did  not  affect  the  young.  It 
does,  as  I  stated  above,  but  not  often,  and  this 
reason  is  possibly  due  to  vigorous  growth  of  the 
cells  in  the  young,  which  are  less  subject  to  can- 
cer, but  more  susceptible  to  poison;  but  the  active 
lymphatics  of  the  young  cause  a  rapid  dissemina- 
tion of  the  disease  when  it  does  occur.  In  very 
old  people  cancer  travels  very  slowly  on  account 
of  the  obliterated  and  sclerosed  condition  of  the 
lymphatics,  and  the  same  obtains,  as  a  rule  in 
tlie  various  infections  of  the  old.  I  have  noticed 
a  number  of  times  in  cases  of  cancer  about  the 
face  and  the  breast  in  the  aged  that  its  progress, 
as  a  rule,  was  very  slow. 

The  possible  reason  why  the  laity  are  often  so 
afraid  to  have  precancerous  conditions  removed 
is  that  they  know  of  cases  which  have  been  oper- 
ated upon,  and  the  condition  progresses  just  the 
same  until  death.  The  reason  for  this  is,  of 
ci  nirse,  delay. 

The  public  should  he  instructed  that  the  danger 

is  lvl  in  the  operation,  hut  in  the  delay.    Anothei 

■  I   why  distrust   in  cancer  operations  exists 


is  that  hopeless  cases  often  go  to  the  surgeon  and 
are  operated  upon  where  no  good  results  could  be 
expected,  and  consequently  the  death  is  charged 
more  to  surgery  than  to  the  true  cause,  whereas 
if  the  patients  had  not  been  operated  upon  they 
might  have  served  as  living  examples  of  delay. 

Therefore,  we  should  put  everv  effort  forward 
to  inform  the  public  in  regard  to  the  prophylactic 
treatment  of  cancer.  I  hope  and  believe  that  in 
the  near  future  there  will  be  a  better  treatment 
for  cancer  than  the  knife,  but  at  present  it  is  the 
only  true  concpieror,  so  far  as  we  have  one,  and 
this  conquest  is  only  made  when  the  attack  is 
made  in  the  precancerous  or  incipient  stage. 


IS   SYPHILIS   HEREDITARY 


By  E.  K.  Tullidge, 
Baltimore,  Md. 


To  discuss  syphilis  as  a  hereditary  disease  we 
must  first  define  disease,  which,  according  to  Mc- 
Farland,  "is  the  inharmonious  relation  of  the  indi- 
vidual to  his  environment,"  and  second,  obtain  a 
clear,  distinct  idea  of  the  term  hereditary. 

In  the  true  biological  sense  this  term  is  much 
misused  in  medicine  and  surgery,  being  applied 
to  many  pre-natal  conditions  that  have  nothing  to 
do  with  it.  In  biology  the  term  "hereditary"  is 
used  to  describe  conditions  transferred  from 
parent  to  offspring  by  peculiarities  of  the  germ 
plasm.  It  does  not  refer  to  accidental  conditions 
of  pre-natal  life  by  which  the  health  or  perfection 
of  the  offspring  is  affected.  These  conditions  are 
termed  "congenital." 

Alanv  of  the  present-day  biologists  differ  as  to 
whether  acquired  characteristics  can  lie  trans- 
mitted to  the  offspring  or  not.  If  not,  then  there 
can  be  no  such  thing  as  a  hereditary  disease  or  de- 
formity. Lamarck  and  Darwin  believed  firmly  in 
inheritance  and  in  the  transmission  of  acquired 
characteristics;  Darwin  making  it  the  basis  of  his 
theory  of  evolution. 

VVeissmann,  Francis  Galton,  Adami,  and  per- 
haps the  majority  of  the  present-day  biologists, 
doubt  or  disbelieve  its  possibility.  It  seems  certain 
that  experimental  characteristics,  i.  e..  mutilations 
such  as  result  from  circumcision,  amputations,  1111- 
cleations,  etc..  arc  not  transmitted,  but  it  appears 
certain  that  spontaneously  acquired  varia- 
tions from  the  normal  may  be  transmitted. 
\daini  has  suggested  that  heredity  may  be  ex- 


THE    HOSPITAL   BULLETIN 


plained  upon  the  assumption  that  the  idioplasm, 
or  that  part  of  the  protoplasm  possessing  vital 
properties,  is  composed  of  a  mass  of  molecules 
which  form  a  central  ring,  to  which  side  rings 
may  be  attached,  or  from  which  they  may  be  de- 
tached without  alteration  of  the  central  primative 
ring.  Environment  causes  the  central  ring  to  have 
attached  certain  side  chain  combinations,  and  in 
this  way  the  modifications  of  the  tissue  cells  are 
consummated.  In  the  same  way  environment  con- 
ditions lead  to  further  modifications  in  the  forms 
of  new  lateral  chain  combinations.  Those  lateral 
chains  that  are  last  developed  are  the  least  stable 
and  the  most  readily  lost,  while  those  which  have 
been  attached  for  a  long  period  of  time  are  not 
readily  loosened.  Thus  it  is  that  conditions  pro- 
duced by  the  lateral  chains  which  have  been  active 
for  generations  tend  to  persist,  while  those  recent 
changes  in  structure  or  alterations  of  environ- 
ment produce  with  the  general  idioplasm  combina- 
tions too  weak  to  lie  transmitted. 

The  hereditary  conditions  thus  far  considered 
refer  to  immediate  peculiarities,  as  the  possession 
hv  the  parent  of  a  peculiarly  situated  lock  of  white 
hair,  which  peculiarity  is  transmitted  to  the  child, 
or  the  parent  has  six  fingers  or  toes,  which  also 
appear  in  the  offspring. 

In  connection  with  certain  diseases,  hereditary 
conditions  are,  however,  more  remote,  thus  in 
haemophilia,  or  "Bleeders'  disease,"  we  find  a  cer- 
tain mode  of  transmission.  The  male  suffering 
from  the  conditions  may  not  transmit  it  to  his 
immediate  offspring,  though  his  daughters  art- 
very  apt  to  transmit  it  to  their  sons,  thus  skipping 
a  generation. 

Consanguinity  is  a  dangerous  hereditary  con- 
dition from  its  tendency  to  accentuate  family 
weakness,  this  danger  being  in  proportion  to  the 
deviations  from  normal  of  those  concerned. 

Atavism  is  another  peculiarity  in  which  the 
traits  of  remote  ancestors  may  make  their  appear- 
ance, such  as  flat-foot,  receding  forehead,  prog- 
nathism or  protrusion  of  the  lower  jaw,  and 
massive  projecting  ears,  all  characteristics  of  the 
lower  animals  and  simian  race. 

Many  pathologists  divide  the  subject  of  heredity 
into  two  divisions,  namely,  true  heredity,  or  that 
condition  just  discussed,  and  false  or  apparent 
hereditv,  commonly  mistaken  for  heredity  proper, 
and  to  which  is  accredited  those  modifications  of 
the  embryo  by  conditions  occurring  in  pre-natal 
life.     Thus  certain   infectious   diseases,   such    as 


smallpox  and  syphilis,  may  he  transferred  from 
mother  to  foetus  through  the  placental  circulation 
and  cause  the  disease  acquired  from  the  parent. 

Those  predispositions  or  tendencies  which  oc- 
cur in  the  offsprings  of  tuberculous,  cancerous 
and  neurasthenic  subjects  may  depend  upon  trans- 
mitted physiologic  peculiarities,  or  may  be  nothing 
more  than  the  result  of  lack  of  vigor  of  the  germ 
plasm,  whose  development  results  in  a  feeble  indi- 
vidual. 

1  luman  ova  are  free,  or  almost  free,  from  yolk, 
and  are  relatively  very  small.  There  has  not  been 
a  single  observation,  according  to  Adami,  showing 
that  the  mammalian  ova  is  phagocytic,  i.  e.,  able 
to  take  up  foreign  particles.  That  minute  sperma- 
tazoa  should  act  as  carriers  is  still  more  unlikely, 
and  the  possibility  that  they  do  so  has  been  nega- 
tived by  Gartner. 

Adami  has  shown  that  the  minimum  number  of 
tubercle  bacilli  that  will  set  up  peritoneal  infection 
in  the  guinea  pig  is  eight;  in  the  rabbit  24  to  30, 
and  Gartner,  after  obtaining  the  seminal  ejacula- 
tions from  tuberculous  guinea  pigs,  found  that 
only  five  out  of  thirty  ejaculations  contained  a 
sufficient  number  of  bacilli  to  cause  the  disease. 
Rohlff  did  not  once  succeed  in  rendering  rabbits 
tuberculous  by  injecting  them  with  semen  of  men 
suffering  with  phthisis.  Gartner  concludes  that 
the  semen  emitted  by  a  phthisical  patient  does  not 
on  the  average  contain  as  many  as  10  bacilli. 

From  these  experiments  of  Rohlff  and  Gaertner, 
Adami  calculates  that  on  the  average,  human 
seminal  ejaculations  contain  more  than  226,000,- 
000  spermatazoa,  and  if  the  semen  contained  not 
10,  but  1000  spirochetes,  the  chances  that  an  indi- 
vidual spermatazoa  fertilizing  the  ovum  should 
bear  with  it  a  spirochete  and  so  lead  to  germinal 
infection  are  as  one  is  to  226,000.  If  1,000,000 
ratio  would  be  1.226,  only  one  of  85,000,000,003 
spermatazoa  having  a  chance  of  fertilizing  an 
ovum.  One  may  draw  his  own  conclusions  as  to 
the  chance  of  a  spermatazoon  conveying  the  dis- 
ease from  father  to  the  offspring.  It  is  so  ab- 
surdly minute  as  to  be  almost  nil. 

That  cases  of  syphilis  in  the  new-born  are  most 
often  of  late  intrauterine  acquirement  is  made  evi- 
dent by  Chiari,  who  states  that  in  90  per  cent,  of 
infants  presenting  signs  of  syphilis  the  liver  is  the 
seat  of  the  most  syphilitic  disturbances.  Infection 
through  the  placenta  amply  explains  the  condi- 
tions in  infants,  for  all  the  blood  on  its  way 
through   the   placenta   passes  through   the   liver. 


THE    HOSPITAL    BULLETIN 


which  is  thus  the  organ  first  subjected  to  infection. 
Adami  specifically  states  that  whenever  there  are 
active  and  specific  manifestations  of  tuberculosis, 
syphilis  or  other  infective  diseases  of  the  new- 
born child,  the  condition  is  of  intrauterine  acquire- 
ment, and  not  inherited.  This  statement  he  sup- 
ports by  referring  to  the  various  stages  to  which 
one  may  find  the  disease  developed  in  the  new- 
born. 

After  an  interesting  series  of  observations  of 
experiments  on  healthy  does,  Freichmann  con- 
clude! that  bacilli  introduced  into  the  uterus  out- 
side of  the  amnion  may  some  day  later  be  found 
in  the  amniotic  fluid,  whether  through  the  pla- 
centa <  from  maternal  affection),  through  the  wall 
of  the  foetal  sac,  or  by  passage  into  the  developing 
ovum  before  the  sac  has  developed,  organisms 
may  infect  the  embryo.  These  various  means  are 
adequate  t<>  explain  the  phenomenon  without  call- 
ing upon  improbable  infection  of  the  ovum  or 
spermatazoon  prior  to  fertilization. 

Children  of  syphilitic  or  tuberculous  parentage 
who  exhibit  certain  stigma  as  foetal  cachexia,  mal- 
nutrition, senile  expression,  senescence,  even  mal- 
formations, are  those  who  have  acquired  these 
characteristics  presumably  by  the  germ  plasm  pre- 
senting modifications  and  disturbances  peculiar  to 
the  parental  germ  cell. 

After  weighing  the  many  arguments  upon  the 
passage  of  foreign  substances  through  the  pla- 
centa advanced  by  Bonnett,  Hofbauer,  Wallgren, 
Polano,  Schmidlechner,  Liedauch  and  others  who 
have  experimentally  proven  the  transmission  of 
iron,  fat,  albumosis,  toxins  of  diphtheria  and  tet- 
anus, the  organisms  of  pneumonia,  relapsing  fever. 
various  infections  due  to  pyogenic  organisms  and 
typhoid  fever,  which  of  the  many  mentioned  is 
most  frequently  transmitted,  due  no  doubt  to  its 
motility,  it  i<  apparent  that  the  functions  of  the 
placenta  are  not  limited  to  mere  absorption  by 
osmosis.  The  adverse  condition,  namely,  the 
transmission  of  materials  from  the  foetus  to  the 
mother,  lias  been  demonstrated  by  Savoy  and 
Guserow.  Therefore,  we  may  safely  say  that  it 
seems  hardly  probable  that  infection  of  the  foetus 
may  occur  without  some  transmission  of  the  or- 
ganisms, or  their  toxins,  to  the  mother,  and  vice 
versa. 

The  reason  why  the  manifestations  are  not  ap- 
parent at  the  time  of  delivery  is  due  probably  to  a 
latent  stage  or  period  in  which  the  spirochete  de- 


velops a  provisional  immunity  only  to  be  followed 
by  manifestations  of  the  disease  in  later  life. 

Keyes  states,  after  citing  "Colles's  law."  that  the 
mother  of  such  a  syphilitic  child  (  Colles's  Child), 
although  herself  remaining  health}-  many  vears, 
almost  invariably  ultimately  breaks  out  with  ter- 
tiary syphilis  (choc  en  retour),  and  that  therefore 
the  mother  of  a  syphilitic  child,  even  though  she 
remain  apparently  sound,  is  syphilitic. 

In  conclusion,  let  us  suppose  that  should  a  father 
transmit  the  disease  apparently  only  to  the  foetus 
by  the  fertilization  of  an  ovum  by  a  spermatazoon 
conveying  a  spyrochete,  and  to  which  spermata- 
zoon has  been  given  its  one  85.000,000,000  of  a 
chance,  according  to  Adami,  and  should  this  one 
spirochete  be  sufficient  in  itself  to  produce  the 
disease,  which  is  highly  improbable  and  unlikely, 
the  infection  would  not  only  be  confined  to  the 
embryo,  but  would  involve  the  placenta  as  well, 
and  from  there  be  transmitted  to  the  mother.  The 
condition  would  be  a  disease  not  the  result  of 
peculiarities  of  the  germ  plasm,  but  the  result  of 
an  exogenous  or  mechanical  infection,  which  we 
must  admit  in  the  true  biological  sense  is  only  con- 
genital. 

The  explanation  of  the  erroneous  use  of  the 
word  "hereditary"  in  connection  with  this  disease 
by  the  profession  is  probably  due  to  the  only  re- 
centlv  acknowledged  definition  of  the  term. 


The  following  letter  has  been  received  by  Dr. 
Randolph  Winslow  from  Dr.  Judson  J.  Davis, 
class  of  1891,  of  Beaufort,  X.  C. : 

Dr.  Randolph  Winslozv, 

Baltimore.  Md.: 

Dear  Sir — As  an  old  friend  and  well-wisher  of 
m\  old  "Alma  Mater,"  I  am  writing  you  to  ask  if 
you  can  find  two  or  three  young  M.D.'s  who  will 
take  up  some  good  practices  in  the  eastern  section 
of  this  State.  There  are  three  or  four  fine  open- 
ings in  this  section  for  young  men  of  good  char- 
acter who  wish  to  get  in  a  work  that  will  bring- 
in  money  at  once.  I  have  nothing  to  sell,  and  only 
have  the  interest  of  my  old  college  and  my  native 
seetii  in  at  heart.  If  any  of  the  young  men  who  are 
to  graduate  this  spring  wish  further  information 
about  these  openings,  I  will  gladly  give  same  upon 
request. 

■With  best  wishes  for  you  and  the  University, 
Yours   very  truly. 

T.  1.  Davis. 


THE    HOSPITAL    BULLETIN 


AN  ANALYTICAL  STUDY  OF  FIFTY 
CASES  TREATED  IX  THE  GASTRI  >- 
ENTEROLOGICAL  DEPARTMENT  OF 
THE  UNIVERSITY  OF  MARYLAND- 
REVIEWED  WITH  SPECIAL  ATTEN- 
TION TO  THE  ANTHROPOMETRIC 
MEASUREMENTS. 

By  Albert  Hynson  Carroll,  M.D., 

and 

Edw.  A.  Looper  and  Ebw.   P.  Kuli:. 
Class  of  1912. 


Any  new  method  or  aid  in  the  diagnosis  of 
pathological  conditions  is  not  only  of  interest  to 
the  specialist,  but  to  the  profession  as  a  whole. 

The  general  practitioner  appreciates  and  makes 
use  of  the  Widal  test  in  typhoid,  and  the  Was- 
herman reaction  in  luetic  conditions. 

The  obstetrician  often  can  predict  the  outcome 
of  a  definite  ease,  basing  his  prognosis  on  a  knowl- 
dge  of  die  pelvic  measurements. 

The  gastro-enterologist  has  developed  a  valu- 
able aid  in  the  diagnosis  of  splanchnoptosis  by 
studying  the  anthropometric  measurements,  and 
in  his  effort  to  arrive  at  an  index. 

Eecher  and  Lenhoff  obtained  an  index  which 
was  arrived  at  by  dividing  the  jugulo-pubic 
distance  by  the  circumference  of  the  waist,  and 
multiplying  this  by  100.  The  higher  the  index, 
the  -mailer  is  the  capacity  of  the  thoracic  cavity. 
The  error  lies  here  in  measuring'  over  and  around 
such  a  variable  part  of  the  anatomy  as  the  ab- 
di  imen. 

R.  S.  Smith"  based  his  observations  on  the 
varying  depths  of  the  thoracic  cavity.  His  in- 
vestigations showed  that  in  enteroptotic  women 
the  depth  ranged  from  13  to  17  cm.,  while  in 
vigorous  ones  it  was  from  16  to  20  cm.  11. 
Stiller,  a--  early  a-  1896,  pointed  out  the  heredi- 
tary condition  and  elaborated  the  "floating  tenth 
rili"  idea,  an  anomaly  often  occurring  in  the 
habitus  enteropti  iticus. 

1  [emmeter,  in  attempting  to  arrive  at  an  index, 
has  taken  measurements  from  fixed  bony  land- 
marks. The  measurements  given  in  this  report 
are  obtained  according  to  his  method.  Although 
the  number  of  cases  investigated  is  small,  the  re- 
sults are  significant. 


The  mass  of  figures  obtained  in  any  such  series 
of  measurements  soon  become  unwieldy  and  are 
perhaps  of  value  mostly  for  statistical  purposes. 
Although  the  securing  of  such  data  is  quite 
tedious,  the  study  is  a  most  interesting  one.  and 
serves  also  to  give  more  accurate  information 
as  to  the  relationship  existing  between  the  various 
forms  of  neuroses  associated  with  splanchnoptosis. 

The  size  and  form  of  the  thorax  as  seen  and 
estimated  by  such  measurements,  indicates  closely 
the  position  of  the  abdominal  viscera,  and  al- 
though we  can  not  predict  with  mathematical 
exactness  the  position  of  the  viscera,  it  will  fie 
found  to  correspond  very  closely  indeed  to  the 
outward   sign-. 

Visceral  prolapse  may  be  either  congenital  or 
acquired.  When  acquired  it  is  usually  the  re- 
sult of  child-bearing  or  of  excessive  hard  work. 

In  the  congenital  form  I  think  that  a  far 
greater  number  of  males  are  affected  than  is 
generally  suspected.  Nearly  all  of  the  observers 
constantly  refer  to  the  "enteroptotic  woman."  In 
our  clinic  we  treat  almost  as  many  males  as  fe- 
males  for  prolapsed  viscera. 

In  congenital  splanchnoptosis  at  least,  the  dis- 
placements accompany  a  lessened  capacitv  of  the 
thoracic  cavity,  which  is  primarily  determined  by 
the  structure  of  its  bony  framework.  And  when 
such  displacements  are  corrected  the  neuroses  ac- 
companying such  displacements  are  quite  fre- 
quently eliminated  or  improved.  At  the  same 
time  those  forces  which  were  lacking,  for  the 
proper  development  of  the  thoracic  walls  exert 
a  profound  effect  on  the  abdominal  musculature, 
and  those  supports  which  normally  hold  the  vis- 
cera in  position. 

W.  J.  Butlerf  reviews  the  previous  literature 
and  adds  some  interesting  observations  concern- 
ing the  acquired  as  well  as  the  hereditary  form 
of  the  enteroptotic  habit.  He  believes  that  evi- 
dences are  observable  during  childhood,  but  that 
actual  ptoses  are  practically  first  seen  at  the 
period  of  puberty. 

It  is  not  a  satisfactory  state  of  affair-  to  be 
content  alone  to  relieve  this  condition  which  often 
only  evidences  itself  in  later  life,  but  we  should 
seek  ways  of  preventing  its  full  development. 

The  frail  child  should  be  watched,  and  its 
tendencies  more  intelligently  fought  by  main- 
taining a  fair  state  of  nutrition  in  order  to  direct 


1.  1/.  A.,  October,  linn. 


Uour.  A.  If.    I„  I mi-  1     1911 


8 


THE    HOSPITAL    BULLETIN 


it  to  a  more  vigorous  adult  condition.  Much  has 
been  said  of  late  regarding  treatment  but  I  have 
not  seen  systematic  muscular  exercises  advocated 
for  such  children.  It  appears  to  me  that  if,  in  the 
frail  child,  properly  directed  exercises;  the  kind 
that  would  tend  to  increase  the  diameters  by 
strenghening  the  respiratory  muscles,  and  hence 
the  capacity  of  the  chest,  and  which  would  develi  ip 
the  muscles  in  the  abdominal  walls  were  insti- 
tuted, many  cases  which  in  adult  life  are  classed 
as  suffering  with  Glenard's  disease,  would  escape 
with  none  or  only  a  few  symptoms  of  this  dis- 
tressing condition. 

hi  the  analyses  of  these  gastroenterological 
cases  attention  has  been  especially  directed  to  the 
study  of  the  anthropometric  measurements.  This 
collection  does  not  consist  of  a  chosen  group,  but 
represents  rather  fairly  the  type  of  cases  coming 
before  our  clinic  at  the  University  of  Maryland 
from  year  to  year. 

Each  of  these  histories  was  prepared  by  two 
students  working  in  the  dispensary  clinic  under 
direction,  and  later  it  was  read  by  one  of  them 
before  the  entire  class  and  criticised  at  the  weekly 
clinic.  In  nearly  every  case  the  patient  was  pre- 
sented also  at  this  time  and  seen  by  Dr.  J.  C. 
1  [emmeter  while  the  history  was  being  read.  Any 
suggestions  or  alterations  then  made  by  him  were 
incorporated  before  it  was  finally  accepted  and 
filed  for  future  reference. 

It  is  interesting  to  know  that  16  per  cent,  were 
cases  of  gastroptosis  or  enteroptosis  and  that  68 
per  cent,  were  cases  of  hypochlorhydria  or  were 
anacid  in  character.  Eight  per  cent,  were  carci- 
noma and  io  per  cent,  were  cases  of  acute  gas- 
tritis. In  one  case  of  lead  poisoning  the  gastric 
symptoms  were  marked,  but  there  was  only  a 
slight  wrist  drop  and  no  blue  line  on  the  gums. 
In  an  undiagnosed  but  carefully  studied  case,  with 
no  etiological  factors  discoverable  to  explain  a 
persistent  vomiting  of  months'  duration,  a  recent 
operation  in  this  hospital  discovered  a  gummatous 
testicle.  There  was  no  history  of  lues,  and  any 
venereal  disease  had  been  stoutly  denied  by  the 
patient,  nor  was  there  any  clinical  evidence  of 
specific  trouble.  Several  gastric  and  one  duo- 
denal ulcer  were  diagnosed  and  operated  on  by 
Dr.  J.  Holmes  Smith  and  Dr.  St.  Clair  Spruill. 

The  "X-ray  bismuth  meal"  method  was  of  de- 
cided value  in  confirming  the  diagnosis  in  several 
ulcer  cases  and  in  one  of  spasm  of  the  cardiac  orifice 


of  the  stomach,  but  in  a  case  of  post-operative 
"viscuous  circle  vomiting"  the  shadow  picture 
was  of  no  diagnostic  value.* 

SPLANCHNOPTOSIS  GROUP. 

In  this  group  (16  per  cent,  of  the  whole  num- 
ber)   the   anthropometric   measurements    showei 
marked   deviations   from    the   distances    between 
established  bony  landmarks  in  normal  individuals. 

It  is  now  generally  accepted  that  when  the 
infrasternal  angle,  i.  e.,  the  angle  formed  by 
drawing  straight  lines  from  the  extremities  of 
the  tenth  ribs  to  the  xyphoid,  is  narrow  and 
measures  75 °  or  less,  that  a  displacement  of  the 
viscera  may  be  present.  If  with  the  above  small 
angle  one  or  both  tenth  ribs,  Stillers  sign,  are 
movable  or  floating,  expectations  are  heightened. 
Again,  if  the  base  of  a  triangle  which  has  for  its 
apex  the  xyphoid  and  for  its  sides  lines  drawn 
from  the  xyphoid  to  the  two  ant.  sup.  spines  of 
the  ilium  is  nine  and  one-half  inches  or  over,  and 
the  chest  is  narrowed  in  both  its  transverse  and 
arterio-posterior  diameters,  a  positive  diagnosis 
can  often  be  predicted  from  inspection  alone. 

In  these  cases  the  angle  averaged  64.5 :. 

The  anthropometric  measurements  averaged  a? 
follows : 

From  manubrium  to  xyphoid,  8.15  inches. 

From  manubrium  to  umbilicus,  14.43  inches. 

From  manubrium  to  symphysis,  21.19  inches. 

From  xyphoid  to  right  ant.  sup.  spin,  ilium. 
1 1  inches. 

From  xyphoid  to  left  ant.  sup.  spin,  ilium.  10.9 
inches. 

The  distance  from  "spine  to  spine"  was  9.75 
inches. 

The  circumference  of  the  chest  at  the  level  of 
the  xyphoid  was  only  29.65  inches. 

The  weight  averaged  121  pounds  and  the  height 
5  feet  6  inches. 

The  youngest  was  27  years  and  the  oldest  was 
48,  with  a  combined  average  of  40. 

Of  these,  35  per  cent,  were  women,  75  per  cent. 
were  white  and  the  remainder  were  colored. 

The  floating  tenth  rib,  which  has  been  men- 
tioned previously,  occurred  in  65  per  cent,  of  these 
cases,  50  per  cent,  having  bilateral  movable  tenth 
ribs. 

It  will  be  noted  that  the  infrasternal  angle  i- 


•It  is  to  lie  remembered  that  to  this  clinic  and  to  Dr. 
Hemmeter,  who  was  aided  in  the  laboratories  by  Dr.  Frank 
Martin,  belongs  the  honor  of  originating  and  firsl  calling 
attention  10  this  method,  although  other  observers  later  have 

rediscovered   his  method. 


THE    HOSPITAL    BULLETIN 


small.    In  no  case  was  it  as  great  as  75°.    In  only 
a  few  of  these  cases  were  both  tenth  ribs  firmly 
attached.     The  left  was  more  often  freely  mo\ 
able  than  the  right. 

There  was  a  noticeable  narrowing  in  both  the 
transverse  and  in  the  anterio-posterior  diameters 
of,  the  thorax,  with  a  marked  elongation  of  this 
structure. 

This  observation  is  of  distinct  diagnostic  sig- 
nificance as  regards  congenital  enteroptosis,  and 
was  associated,  as  is  almost  universally  the  case, 
with  marked  infirmities  of  the  entire  nervous  sys 
tern.  In  all  these  cases  the  stomach  was  markedly 
displaced,  and  in  several  instances  the  greater 
curvature  extended  tei  the  level  of  the  pelvic  brim. 

The  heart  was  also  noted  to  be  displaced  toward 
the  middle  of  the  thorax  in  these  gastroptosis 
cases  where  the  lateral  and  anterio-posterior  di- 
ameters wire  narrowed.  About  33  per  cent,  of 
ises  e:  hibited  associated  neurasthenic  con- 
ditii  in-. 

In  36  per  cent,  of  these  eases  there  was  a 
diminished  secretion  of  I  TCI.  but  in  one  case  there 
was  a  hyperchlorhydria  of  380.  The  total  acidity, 
combined  acids  and  acid  salts  averaged  45°.  In 
all  these  cases  mucus  was  present  in  the  test  meals 
or  in  the  washings,  and  often  in  large  amount. 

The  '  >ppler  Boas  bacillus  was  found  in  several 
-  in  which  there  was  no  suspicion  or  evidence 
of  malignancy. 

The  "modified  glyco-tryptophan"  test  for  can- 
cer was  made  in  a  number  of  suspicious  cases,  but 
rile  results  were  negative. 

Chronic  Mucous  Gastritis.  —  Sixty-eight  per 
cent:  of  these  case-,  were  chronic  in  character. 
high  percentage  can,  however,  be  accounted 
or  lie  the  fact  that  each  ease  is  kept  under  obser- 
vation for  a  sufficient  period  to  make  a  fairly  ac- 
curate diagnosis.  Chronic  cases  naturally  return 
a  sufficient  number  of  times  to  allow  of  a  urinary, 
fecal,  complete  physical  and  blood  examination 
being  made,  as  well  a--  an  analysis  of  tile  Stomach 
contents  after  test  meals. 

Acute  attacks  of  gastritis,  which  are.  however, 
often  quite  transient  in  character  and  frequently 
relieved  by  a  few  treatments,  neglect  to  return  un- 
til a  later  date,  if  at  all.  for  discharge.  This  ren- 
ders the  data  already  obtained  valueless.  I  I 
the  high  average  per  cent,  of  chronic  case-. 

In  these  cases  of  chronic  gastritis  40  per  cent, 
showed  a  condition  of  an  acidity;  33  per  cent. 
showed  a  condition  of  hypoacidity:   21  per  cent. 


showed  a  condition  of  hyperacidity.     The  total 
acidity  averaged  33.05  .    There  were  nearly  twice 

as    many    males    as    females;    52    per   cent,    were 
white  and  48  pel"  cent,  were   colored. 

The  anthropometric  measurements  of  the  above 
class  were  : 

M.  to  X.,  8.02  inches. 

M.  to  l'.,  1  4.24  inch.-. 

M.  to  S.,  i'  1. ''3  inches. 

X.  to  R.  S.  S.,  in. vi  inches. 

X.  to  L.  S.  S..  10.8X  inclh 

S.  to  S.,  9.61  inches. 

C.  at  X..  30.01  inches. 

A.  at  X..V7.340. 

Weight,  131.''  pounds;  height,  5  feet  5  A 
inches:  age,  36  years. 

It  will  be  observed  here  that  the  length  of  the 
line  from  the  manubrium  to  the  symphysis  is  only 
19.65  inches,  while  in  the  enteroptosis  group  it 
was  21.19  inches.  Also  the  circumference  at  X. 
was  less  in  the  enteroptosis  group,  being  only 
29.65  inches.  The  distance  between  the  spines 
of  the  ilium  is  also  less  in  this  last  group,  while 
the  height  is  practically  the  same  in  both.  The 
angle  in  this  second  series  also  exceeded  the  first 
group  by  13°,  while  the  patients  averaged  10 
pounds  heavier. 

CARCINOMA   GROUP. 

Measurements  averaged  ; 

M.  to  X.,  9  inches. 

M.  to  U.,  13.25  inches. 

M.  to  S.,  21.80  inches. 

X.  to  R.  S.,  1 1. 12  inches. 

X.  to  L.  S.,  1 1. 12  inches. 

S.  to  S.,  IO.62  inches. 

C.  at  X.,  31  inches. 

Angle  at  X..  82. 5  '. 

Weight,  km:  pounds;  age,  47  years. 

Three  white;  one  colored;  one  male;  three 
females. 

There  was  an  absence  of  IIC1  in  all  these  ca-e-. 
Oppler  Boas  bacillus  was  present  in  three  of 
them.     Blood  was  found  in  only  one  c 

:  1     1;  \stkitis. 

Measurements: 

M.  to  X.,  7.9  inches. 

M.  to  I'.,  14  inches. 

M.  to  S.,  10.41  inch' 

X.  to  R.  S.  S.,  10.66  inch 

X.  to  L.  S.  S.,  IO.66  inches. 

S.  to  S.,  0.33  inches. 


IO 


THE    HOSPITAL   BULLETIN 


C.  at  X.,  30.33  inches. 

Height.  5  feet  O1..  inches;  weight,  139  pounds: 
age,  28  years. 

HC1  was  diminished  in  three-fifths  of  these 
cases ;  two-fifths  showed  an  anacid  condition. 

Among  the  rarer  diseases  which  were  discov- 
ered after  the  patient  had  applied  for  relief  of 
"stomach  trouble"  was  one  case  of  tubercular  and 
another  of  amebic  dysentery.  There  was  one 
case  of  gastric  crices  with  tabes  dorsalis,  one  of 
true  gastralgia,  and  many  which  were  secondary 
to  chronic  appendicitis,  tubercular  invasion,  pelvic 
disorders,  floating  kidney,  and  so  on. 

One  ulcer  case  showed  a  hyperchlorhydria  of 
900  free  HC1.  There  was  one  case  in  which 
rumination  accompanied  a  hyperacidity,  and  one 
of  wind  swallowing. 

The  average  measurements  for  the  entire  group 
were  as  follows  : 

M.  to  X..  8.34  inches. 

M.  to  I'.,  12.46  inches. 

M.  to  S.,  20.50  inches. 

X.  to  R.  S.  S.,  10.74  inches. 

X.  to  L.  S.  S.,  10.71  inches. 

S.  to  S.,  y.74  inches. 

C.  at  X..  30.71  inches. 

Angle  ai  X..  77.090. 

The  smallest  substernal  angle  was  45°;  the 
largest  was  95°. 

Four  per  cent,  of  the  angles  were  between  900 
and  100° :  3d  per  cent,  of  the  angles  were  between 
<jO°  and  8o°  :  42  per  cent,  of  the  angles  were  be- 
tween 80°  and  700  ;  10  per  cent,  of  the  angles 
were  between  70°  and  60  °  ;  2  per  cent,  of  the 
angles  were  between  60"  and  500  ;  2  per  cent,  of 
the  angles  were  between  50°  and  400. 

The  average  age  of  these  patients  was  yj  years. 
The  youngest  was  13  and  the  oldest  57.  The 
average  weight  was  only  13 1.5  pounds,  and  the 
height  was  5  feet  5  '4  inches. 

Jt  was  interesting  to  note  that  in  many  of  the 
cases  in  which  enteroptosis  existed  there  had  been 
no  previous  history  obtainable  of  marked  or  at 
times  of  any  real  gastric  disturbances  until 
shortly  before  applying  for  treatment.  These 
cases  often,  from  their  general  abearance,  do  not 
suggest  a  condition  of  displaced  viscera  until  dis- 
robed. The  diagnosis  then  should  be  as  easily 
made  as  is  the  condition  of  contracted  pelves  to 
the  obstetrician  or  the  probable  present  or  past 
existence  of  adenoids  to  the  rhinologist, 


These  cases  fairly  well  represent  the  clinical 
material  available  for  study,  as  they  are  similar 
t<>  the  class  of  patients  presenting  themselves 
from  year  to  year  at  the  dispensary  clinic,  where 
over  1700  treatments  were  given  in  the  "stomach 
box"  alone  to  over  500  patients  in  1910. 

Of  these,  65  per  cent,  were  males,  35  per  cent, 
females,  67  per  cent,  white  and  33  per  cent,  col- 
ored ;  J2  per  cent,  were  married.  The  youngest 
treated  was  12  years  old,  and  the  oldest  67,  the 
average  being  34  years,  and  the  average  above  30 
was  42  years.  Over  50  distinct  occupations  were 
represented,  and  of  these  "laborers,  housewives 
and  tailors"  were  far  in  the  majority. 

There  has  been  but  little  effort  in  this  analysis 
to  draw  any  conclusions.  We  endeavored  only 
to  arrive  at  averages  in  regards  to  age.  sex,  occu- 
pations, anthropometric  measurements,  chemical 
examination  of  gastric  contents,  etc. 


THE  SYMPTOMATOLOGY  OF  TYPHOID 
FEVER  AND  ITS  COMPLICATE  >NS. 


By  C.  \Y.  RauschenbacHj 

Senior  Medical  Student. 


In  the  consideration  of  the  symptomatology  01 
typhoid  fever  it  should  be  borne  in  mind  that 
typhoid,  or  enteric,  fever  varies  considerably  in 
individual  cases  both  as  regards  character  and 
intensity,  this  being  due  partly  to  the  virulence 
and  localization  of  the  poison  and  partly  to  a 
mixed  infection. 

Statistics  show  that  at  least  50  per  cent,  of  all 
cases  occur  during  the  months  of  August.  Sep- 
tember and  Octoberj  and  two-thirds  of  all  cases 
between  the  ages  of  15  and  30;  yet  you  should  be 
ever  mindful  of  the  fact  that  in  the  temperate  zone 
it  is  an  endemic  disease,  affecting  those  of  all  ages, 
the  youngest  and  oldest  cases  reported  being,  re- 
spectively, aged  six  months  and  J^,  years. 

There  is  no  one  early  symptom  of  the  disease 
which  is  diagnostic,  but  it  is  the  syndrome,  viz., 
chilly  sensations,  headaches,  lassitudes,  inapti- 
tude for  work,  anorexia,  diarrhea,  epistaxis,  ab- 
dominal pain,  which  come  on  insidiously  ami 
grow  progressively  worse,  which  is  suggestive. 
Any  "lie  of  the  above  symptoms  may.  however, 
so  predominate  the  scene  that  unless  you  are  a 
careful  examiner  you  may  fail  to  elicit  the  other 
symptoms  from  the  patient,  and  hence  may  mis- 
take the  condition   for  one  of   an  acute  neurotic. 


THE    HOSPITAL    BULLETIN 


ii 


pulmonic,  gastric   or  nephritic   disorder  by   the 

predominance  of  their  respective  symptoms.  Dur- 
ing this  stage  the  patient  usually  meanders  about 
the  house,  and  finally  takes  to  bed. 

During  the  first  week  after  going  to  bed  the 
most  characteristic  conditions  which  will  aid  you 
in  your  diagnosis  are  noted,  viz.,  the  steady  rise 
of  fever,  the  evening  record  rising  a  degree  to  a 
degree  and  a  half  higher  each  day  until  reaching 
103-1040  Fahr.;  the  relative  bracchycardia,  from 
100  to  110,  with  a  pulse  of  full  volume,  low  ten- 
sion and  very  often  dichrotic.  and  finally  toward 
the  end  of  the  week  the  enlargement  of  the  spleen, 
the  outcropping  of  the  rose  spots,  and  tympanitis 
clinch  the  diagnosis.  All  during  this  period  the 
patient  usually  complains  of  a  cough,  bronchitis, 
headaches,  and  may  even  have  mental  confusions 
and  wandering  at  night. 

During  the  second  week  after  taking  to  his  bed 
all  the  symptoms  become  aggravated,  the  fever 
remains  high,  the  morning  remissions  are  slight, 
the  pulse  becomes  rapid  and  loses  its  dichrotic 
character,  the  face  looks  heavy,  and  the  tongue  in 
severe  cases  becomes  dry  and  covered  with  a 
brownish  fur. 

In  the  third  week  the  temperature  shows 
marked  morning  remissions,  and  there  is  a  grad- 
ual decline  in  the  fever.  Diarrhea  and  meteorism 
may  now  occur  for  the  first  time,  and  vou  also 
have  the  coming  on  of  the  signs  of  weakness,  viz., 
loss  of  rlesh.  feebleness  of  the  heart  and  muscular 
tremors. 

With  the  fourth  week  convalescence  usually  be- 
gins, the  temperature  reaches  the  normal  point, 
the  diarrhea  stops,  the  tongue  cleans  and  the  de- 
sire for  food  returns. 

SPECIAL    SYMPTOMS    AND     SERUM     DIAGNOSIS. 

Rose  spots  are  characteristic  hyperemic  spots 
which  appear  from  the  seventh  to  tenth  day.  and 
usually  first  upon  the  abdomen.  They  are  slightly 
raised,  flattened  papules,  which  can  be  distinctly 
felt  by  the  finger,  of  a  rose-red  color  and  disap- 
pearing upon  pressure.  They  come  out  in  suc- 
cessive crops,  and  after  persisting  for  two  to  three 
days  disappear,  occasionally  leaving  a  brownish 
stain,  especially  in  brunettes.  These  spots  occa- 
sionally appear  first  upon  the  back  and  lower  por- 
tion of  front  chest  wall  instead  of  upon  the  abdo- 
men, and.  indeed,  in  the  past  season  this  has  been 
the  rule  instead  of  the  exception  at  this  hospital. 

Blood. — Nearly  all  cases  of  typhoid  are  associ- 
ated with  an   anemia,   some  reaching*  as   low   as 


1.300,000  R.   1!.  C.     In  all   uncomplicated  cases 

there  is  a  leucopenia,  with  a  relative  lymphocyto- 
sis. I  hie  to  the  anemia,  the  hemoglobin  is  re- 
duced, but  the  color  index  is  plus  1.  It  should 
also  be  remembered  that  typhoid  is  a  bacteremia. 

G astro-intestinal  Symptoms.  —  The  symptoms 
of  this  tract  should  be  considered  merely  as  mani- 
festations of  hyperirritability,  and  hence  you  may 
have  either  constipation,  diarrhea,  or  alternately 
constipation  and  diarrhea. 

Bronchitis  is  one  of  the  most  frequent  of  the 
initial  symptoms.  Epistaxis  precedes  typhoid 
more  frequently  than  any  other  febrile  affection. 

Ehrlich's  Diaso  Reaction. — This  test  has  fallen 
into  disuse  hecause  of  its  unreliability,  i.  c,  not 
all  cases  of  typhoid  react,  and  a  positive  reaction 
occurs  in  miliary  tuberculosis,  malaria,  and  occa- 
sionally in  other  conditions  associated  with  high 
temperatures. 

Widal's  Agglutinative  Test. — As  regards  this 
test,  it  should,  in  the  first  place,  be  borne  in  mind 
that  the  formation  of  agglutinins  is  a  process 
which  proceeds  simultaneously  with  the  establish- 
ment of  immunity,  and  therefore  the  reaction 
rarely  develops  before  a  week  or  10  days.  It  is 
not  absolutely  diagnostic,  as  other  microbic  infec- 
tions may  give  the  reaction,  but  these  conditions 
are  rare,  and  in  only  2l/2  per  cent,  of  cases  is  it  in 
error,  whilst  it  is  present  in  00  per  cent,  of  all 
cases  of  typhoid  infection.  This  reaction  may 
persist  for  many  years  after  the  disease,  ami  hence 
the  fact  of  having  had  typhoid  before. or  having 
been  immunized  against  it  by  vaccines  should 
always  be  taken  into  consideration.  It  should 
also  lie  borne  in  mind  that  the  reaction  is  not  an 
index  as  to  the  severity  of  the  disease,  as  you  may 
readily  obtain  agglutination  in  mild  cases  and 
again  secure  none  in  severe  cases,  or  vice  versa. 

Recovery  of  Typhoid  Bacilli. — The  recovery  of 
typhoid  bacilli  from  the  patient's  blood  or  from 
suspected  rose  spots  is  absolutely  indicative  that 
the  illness  is  that  of  typhoid,  but  this  is  a  pro- 
cedure not  practical  for  the  average  physician. 
The  recovery  of  typhoid  bacilli  from  the  feces 
and  urine,  a  difficult  procedure,  does  not.  however. 
necessarily  indicate  that  the  condition  is  typhoid, 
as  carriers,  and  even  those  who  have  not  had  the 
disease,  sometimes  harbor  them  in  their  gall-blad- 
der and  kidney. 

SYMPTOMS    OF     COM  PLK  ATI0NS. 

Hemorrhage. — From  the  end  of  the  second  to 
the  beginning  of  the  fourth  week  one  should  al- 


12 


THE    HOSPITAL    BULLETIN 


ways  be  on  the  alert  for  hemorrhage,  and  espi  ■ 
ally  if  tympanitis  be  present.  The  most  charac- 
teristic symptoms  of  it  are  a  sudden  drop  of  six 
to  seven  degrees  of  temperature  within  a  few 
hours,  with  a  corresponding  rise  in  the  pulse  and 
respiratory  rates,  and  the  former  may  even  cross 
the  temperature  curve.  Later  blood  will  appear 
in  the  stools,  either  fresh  or  tarry,  and  there  is  a 
soft,  boggy  mass  in  the  abdomen.  You  should 
not.  however,  wait  for  the  blood  to  appear  in  the 
stools  before  starting  treatment,  but  if  the  other 
symptoms  above  mentioned  be  present  it  is  best 
to  always  presume  hemorrhage  to  be  present  and 
immediately  institute  treatment,  for  by  such  a 
procedure  you  can  do  your  patient  no  harm,  and 
in  the  majority  of  cases  it  will  later  be  found  by 
the  blood  in  the  stool  that  hemorrhage  has  oc- 
curred. 

Perforation. — The  symptomatology  of  this  seri- 
ous complication  as  described  in  the  various 
standard  textbooks  would  never  lead  one  to  make 
an  early  diagnosis  of  perforation,  but  would 
necessitate  the  oncoming  of  a  peritonitis  before 
recognition.  This  was  first  pointed  out  by  Dr. 
Bagley  of  this  city.  Perforation  usually  first  man- 
ifests itself  by  the  sudden  oncoming  of  sharp 
lancinating  pains  over  McBurney's  point,  extreme 
tenderness  over  the  same  area,  and  muscular 
rigidity  due  to  a  spasm  of  the  rectus  muscle.  The 
occurrence  of  these  three  cardinal  signs  without 
any  other  reactions  would  warrant  an  explora- 
tory laparotomy,  as  typhoids,  relatively,  bear  op- 
erations exceedingly  well.  You  should  never  wait 
for  the  Hippocratic  fades,  thready  pulse,  vomit- 
ing, leucocytosis,  shallow  respirations,  etc. — as 
these  are  symptoms  of  peritonitis,  and  after  their 
development  the  chances  of  the  patient  are  mark- 
edly les-ened.  From  the  above  it  is  seen  that  it  is 
absolutely  essential  that  everyone  treating  a  case 
of  typhoid  should  become  perfectly  familiar  with 
his  patient's  abdomen,  and  especially  so  if  hem- 
orrhage has  occurred,  as  20  per  cent,  of  all  per- 
forations are  preceded  by  hemorrhage. 

7  he  Symptoms  of  Typhoid  in  Children. — Ty- 
phoid runs  a  much  milder  course  in  children,  and 
the  severity  of  the  symptoms  bears  a  direct  rela- 
tii  mship  to  the  age  of  the  patient,  i.  e..  the  younger 
the  patient  the  less  severe  the  symptoms  and 
course  of  die  disease.  There  is  frequently  a  sud- 
den onset,  with  fever,  prostration  and  vomiting. 
c  hills  and  epistaxis  are  e<  >mparatively  rare.  There 


may  be  absolutely  nothing  characteristic  of  the 
alimentary  tract  or  there  may  be  mild  constipa- 
tion or  diarrhea.  The  skin  eruption  is  less  abun- 
dant, less  constant  and  less  characteristic  than  in 
adults.  The  initial  rise  in  the  temperature  curve 
is  more  rapid,  the  remittant  character  during  the 
second  week  is  less  marked,  and  the  average  dura- 
tion is  shorter  than  in  adults.  The  pulse  is  rela- 
tively rap/id,  and  dicrotism  rare  as  compared  with 
adults.  As  a  rule,  the  nervous  manifestations  are 
much  more  prominent  than  the  intestinal  symp- 
toms, but  the  extreme  neurotic  disorders  are  rare- 
ly seen,  headaches  and  mild  delirium  at  night  be- 
ing the  chief  manifestations.  Occasionally  in 
severe  cases  the  nervous  symptoms  may  simulate 
meningitis. 

Resume. — From  the  foregoing  it  is  seen  that 
the  salient  points  upon  which  a  conclusive  diag- 
nosis of  typhoid  may  he  established  are: 

1.  The  demonstration  of  the  specific  causal 
agent,  the  typhoid  bacilli,  in  the  body  of  the  pa- 
tient. 

2.  By  the  demonstration  of  the  changes  in  the 
blood  and  tissue  fluids  giving  their,  specific  agglu- 
tinative properties,  and 

3.  The  recognition  of  a  symptom-complex, 
viz.,  the  temperature  curves,  the  intestinal  symp- 
toms, the  characteristic  rash,  the  enlarged  spleen 
and  other  less  prominent  symptoms:  character- 
istic of  the  reaction  of  the  organism  to  the  typhoid 
bacillus.  . 

The  Eta  Chapter  of  the  Phi  Sigma  Kappa  gave 
an  "At  Home"  to  their  friends  at  their  new  home, 
816  Park  avenue,  February  0.  i')i2. 


Extracts  from  some  letters  : 

"With  my  best  wishes  for  a  successful  year."' — 
George  H.  Steuart.  M.D.,  class  of  1800.  of  Otto- 
man, I  'a. 

"Can"t  afford  to  he  without  The  Bulletin,  as 
it  keeps  me  in  touch  with  what  is  going  on  at  the 
old  University.  I  find  something  in  every  number 
that  is  both  interesting  and  instructive,  ['ve  en- 
joyed Prof.  Winslow's  'See  America  First';  also 
Prof.  Ashby's  'A  Hurried  Trip  Through  Eu- 
rope.' "—/r.  C.  Curry.  M.D.,  class  of  [881,  Flem- 
ington,  W.  J 'a. 

"1  enjoy  reading  Tin:  BULLETIN  very  much, 
and  am  always  glad  when  it  comes  to  my  desk." — 
T.  .  I.  Matthews,  M.D.,  class  of  1890,  Castalia, 
North  Carolina. 


THE    HOSPITAL    BULLETIN 


13 


THE  HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

PUBLISHED    BY 

THE   HOSPITAL   BULLETIN    COMPANY 

608  Professional  Building 

Baltimore,  Md. 


Subscription  price, 


$1.00  per  annum  in  advance 


Reprints  furnished  at  cost.     Advertising  rates 
submitted  upon  request 


Nathan    Winslow,  M.D.,  Editor 


Baltimore,  March  15,  191: 


RETROSPECT  .VXD  PROSPECT. 


In  1893  the  Medical  School  of  the  University 
of  Maryland  had  been  So  years  in  existence,  and 
there  was  not  one  cent  of  endowment.  Some  years 
previously  a  futile  attempt  was  made  to  secure 
fund-,  to  the  extent  of  appointing  a  committee, 
whose  names  were  published  in  the  animal  an- 
nouncement, and  there  the  effort  ceased.  In  1893 
J  >r.  Eugene  E.  Cordell,  then  and  now  an  enthusi- 
astic anil  loyal  alumnus,  had  a  clear  vision  of  the 
urgent  necessity  for  an  endowment,  and  sounded 
a  clarion  note  of  warning-  and  a  ringing  appeal 
for  aid.  This  appeal  fell  upon  deaf  ears  and  on 
stony  hearts.  In  1897,  at  a  meeting  of  the  alumni 
held  in  Chemical  Hall  in  the  Medical  School,  Dr. 
Cordell  again  sounded  the  alarm  and  called  for 

criptions.    Dr.  Randolph  Winslow  of  the  class 

■ose  and  said  he  wished  to  be  the  first  to 

contribute  to  a  fund  for  the  endowment  of  the 

".Medical    School,   and   a   number   of   others   also 

.■'■d  their  support.  The  fund  increased  very 
slowly,  but  during  the  year  1007.  as  a  result  of 
the  centennial  celebration  of  the  founding  of  the 
University,  a  considerable  increment  was  secured. 
Funds  were  established  for  various  purposes, 
hut  practically  fur  two  great  objects — in 
the  endowment  of  the  Medical  School,  (2)  an 
endowment  fund  for  general  University  purpi 
In  the  nearly  five  years  that  have  elapsed  since  the 
centennial  celebration  these  funds  have  gradually 
grown,  mostly  through  the  unselfish  efforts  of  Dr. 
*  '<  irdell,  and  the  total  amount  of  the  funds  now  in 


hand  is  considerably  more  than  $40,000.  This  is 
not  a  large  sum.  but  it  is  a  long  way  better  than 
nothing,  and  it  is  increasing  steadily.  The  Fac- 
ulty of  Physic  fund,  which  can  he  applied  to  the 
chair  of  pathology,  at  this  writing  amounts  to 
$16,882  in  hand.  The  Robinson  bequest  has  been 
paid  and  is  in  the  hands  of  the  trustees  of  the 
Endowment  Fund,  though  a  generous  deduction 
was  made  by  the  State  for  the  collateral  inherit- 
ance tax.  We  are  therefore  making  progress 
and  we  must  not  be  discouraged.,  but  must  re- 
double our  efforts,  and  look  forward. 


SECOND  (ALE  FOR  DINNER. 


Twelve  months  have  rolled  around  since  we 
first  began  the  effort  to  raise  $100,000  for  the 
endowment  of  the  department  of  pathology.  The 
work  was  undertaken  because  we  saw  an  impera- 
tive need,  and  because  there  was  no  one  else  who 
seemed  able  or  willing  to  make  the  effort.  It  is 
an  effort  that  is  not  only  distasteful  to  the  writer, 
but  one  for  which  he  feels  his  unfitness.  He  has 
expended  his  energies  mostly  upon  the  graduates 
of  the  Medical  School,  and  wdiile  the  results  have 
not  been  in  proportion  to  the  effort,  he  is  pro- 
foundly thankful  to  the  considerable  number  who 
have  responded  to  the  call.  A  widespread  inter- 
est has  been  aroused,  and  we  believe  there  arc 
many  others  who,  as  time  and  opportunity  pre- 
sent, will  contribute  to  the  cause.  Since  the  ap- 
peal was  first  made,  in  March,  1911,  conditions 
have  greatly  changed,  and  we  are  now  confronted 
with  the  necessity  of  supplying  six  paid  labora- 
tory instructors,  who  must  devote  their  entire 
time  to  teaching  and  research.  A  school  will  not 
be  in  good  standing  that  does  not  comply  with 
this  requirement,  and  its  graduates  will  not  be 
allowed  to  practise  in  New  York.  The  Council 
on  Medical  Education  of  the  American  Medical 
ociation  and  the  Association  of  American 
Medical  Colleges  view  askance  schools  that  do  not 
have  their  scientific  chairs  filled  by  full-time,  sal- 
aried instructors.  The  University  of  Maryland 
must  not  lag  in  the  rear,  but  must  keep  in  the 
advance.  This  will  still  further  strain  our  re- 
sources, and  make  it  still  more  imperative  that  we 
receive  assistance  from  our  friends.  Many  of  us 
in  our  travels  who  may  have  neglected  to  re^p 
to  the  call  to  dinner,  or  who  may  have  been 
crowded  oul   by  others  more  vigilant  than  our- 


V 


14 


THE    HOSPITAL   BULLETIN 


selves,  know  how  pleasant  is  the  voice  of  the 
dusky  herald  as  he  passes  through  the  train  and 
cries  "Second  call  for  dinner!"  We  also  are  now 
passing  through  the  train,  and  we  loudly  cry, 
"Second  call  for  dinner!" 

The  subscriptions  to  March    i,   191 2,  are  as 

follows : 

Robinson   bequest $5000  00 

Dr.  Hugh  Hampton  Young,  J.  H.  U. . .  100  00 

Prof.  R.  Dorsey  Coale,  Ph.D 100  00 

Dr.  S.  J.  Meltzer,  LL.D.,  New  York. . .  10  00 

Dr.  Gideon  Timberlake 25  00 

Dr.   Gordon   Wilson 50  00 

Mr.  H.  P.  Ohm 10  00 

Dr.  Samuel  W.  Moore,  D.D.S 25  00 

Dr.  A.  Sagebein,  D.D.S. ,  Cuba 5  00 

Thomas  C.  Basshor  Company 10  00 

Hospital  Bulletin 10  00 

Maryland  Medical  Journal 5  00 

Miss  C.  M.  Selfe 5  00 

Mr.  George  Lewis,  Florida 50  00 

Mr.  J.  Henry  Smith 25  00 

Mr.  R.  A.  Krieger 5  00 

Summers  Printing  Co 15  00 

Williams  &  Wilkins  Company 50  00 

Geo.  W.  Walther  &  Co 15  00 

Muth  Bros.  &  Co 10  00 

Dr.  John  J.  R.  Krozer,  1848 50  00 

Dr.  Eugene  F.  Cordell,  1868 10  00 

Dr.  John  G.  Jay,  1871 25  00 

Dr.  C.  R.  Winterson,  1871 10  00 

Dr.  Chas.  H.  Diller,  1872 20  00 

Dr.  Joseph  T.  Smith,  1872 10  00 

Dr.  W.  J.  Young,  1872 25  00 

Dr.  Isaac  S.  Stone,  1872 10  00 

Dr.  Thomas  A.  Ashby,  1873 100  00 

I  )r.  David  W.  Bulluck,  1873 100  00 

Dr.  Robert  Gerstell,  1873 5  00 

Dr.  Randolph    Winslow,    1873 100  00 

Dr.  James  W.  Humrichhouse,  1873.  ...  25  00 

Dr.  1 1.  T.  Harrison,  1874 5  00 

Dr.  John  D.  Fiske,  1875 5  00 

Dr.  Wilmer  Brinton,  1876 100  00 

Dr.  Wm.  E.  Wiegand,  1876 10  00 

1  >r.  Thomas  Chew  Worthington,  1876.  .  5  00 

Dr.  R.  II.  P.  Ellis,  1877 10  00 

Dr.  I..    Ridgely    Wilson,    1880 5  00 

Dr.  Charles  S.  Mitchell.  1881 100  00 

1  )r.  1..  Ernest  Neale,  1881 100  00 

Dr.  F.  L.  Meierhof,  1S81 50  00 

I  >r.  James  M  Craighill,  1882 25  00 


Dr.  J.  M.  Hundley,  1882 250  00 

Dr.   Henry   Chandlee,    1882 25  00 

Dr.  Benjamin  F.  McMillan,  1882 10  00 

Dr.  Charles  C.  Harris,  1883 10  00 

Dr.  Louis  W.  Talbott,  1883 25  00 

Dr.  Isaac  H.  Davis,  1885 100  00 

Dr.  B.  Merrill  Flopkinson,  1885 25  00 

Dr.  J.  C.  Perry,  1885 100  00 

Dr.  H.  C.  Reamer,  1885 10  00 

Dr.  Frank  Martin,  1886 100  00 

Dr.  John  R.  Winslow,  1888 50  00 

Dr.  C.  W.  McElfresh,  1889 100  00 

Dr.  Joseph  E.  Gichner,  1890 25  00 

Dr.  St.  Clair  Spruill,  1890 150  00 

Dr.  Rupert  Blue,  1892 100  00 

Dr.   Frank  J.  Kirby,  1892 50  00 

Dr.  Andrew  J.  Crowell,  1893 10  00 

Dr.  Walter  B.  Kirk,  1893 5  00 

Dr.  Martin  J.  Cromwell,  1894 50  00 

Dr.  Charles  T.  Harper,  1894 50  00 

Dr.  Henry  Lee  Smith,  1894 10  00 

Dr.  Geo.  H.  Hammerbacher,  1894 25  00 

Dr.  Harry  Adler,  1895 100  00 

Dr.  Jose  L.  Hirsh,  1895 50  00 

Dr.  John  McMullen,   1895 5  00 

Dr.  Joseph  W.  Holland,  1896 50  00 

Dr.  R.  W.  Sturgis,  1896 2  00 

Dr.  Robert  H.  McGinnis,  1897 5  00 

Dr.  Compton  Riely,  1897 50  00 

Dr.  Guy  Steele,  1897 15  00 

Dr.  Page  Edmunds,  1898 50  00 

Dr.  Albert  J.  Bossyns,  1898 5  00 

Dr.  Edward  E.  Lamkin,  1898 25  00 

Dr.  L.  W.  Armstrong,  1900 10  00 

Dr.  S.  Demarco,  1900 50  00 

Dr.  M.  S.  Pearre,  1900 5  00 

Dr.  Irving  J.  Spear,  1900 50  00 

Dr.  William  Tarun,   1900 50  00 

Dr.  John  Houff,  1900 25  00 

Dr.  Wm.  II.  Smith,  1900 25  00 

Dr.  J.  D.  Reeder,  1901 50  00 

Dr.  Nathan  Winslow,  1901 50  00 

Dr.  Wm.  R.  Rogers,  190T 25  00 

Dr.  Frederick  N.  Nicholls,  1902 15  00 

Dr.  Arthur  M.  Shipley,  1902 250  00 

Dr.  II.  C.  Davis,  1902 10  00 

Dr.  II.  L.  Rudolf,  1902 25  00 

Dr.  Wilbur  P.  Stubbs,  1902 5  00 

Dr.  Hugh  Brent,  1903 25  00 

Dr.  A.  R.  Hunter,  1903 25  00 

Dr.  Louis  B.  Henkel,  1903 25  00 

Dr.  G.  C.  Lockard,  1903 25  00 


THE    HOSPITAL   BULLETIN 


15 


Dr.  Geo.  S.  M.  Kieffer,  1903 25  00 

Dr.  H.  J.  Maldeis,  1903 25  00 

Dr.  Howard  J.  Iglehart,  1903 25  00 

Dr.  Howard  W.  Jones,  1903 25  00 

Dr.  John  T.  O'Meara,  1903 25  00 

Dr.  Fred  L.  Wilkins,  1903 25  00 

Dr.  Albert  L.  Wilkinson,  1903 25  00 

Dr.  R.  C.  Metzel,  1904 10  00 

Dr.  Ejnar  Hansen,  1904 10  00 

Dr.  Charles  Bagley,  Jr.,  1904 25  00 

Dr.  Alvin  B.  Lennan,  1904 25  00 

Dr.  Walter  Van  Sweringen,  1904 25  00 

Dr.  M.  A.  Weinberg,  1904 25  00 

Dr.  Herbert  E.  Zepp,  1904 25  00 

Dr.  Robert  Bay,  1905 100  00 

Dr.  B.  F.  Teft't,  1905 100  00 

Dr.  Edward  L.  Bowlus,  1906 5  00 

Dr.  Joseph  A.  Devlin,  1906 10  00 

Dr.  W.  F.  Sowers,  1906 25  00 

Dr.  R.  W.  Crawford,  1906 25  00 

Dr.  Matthew  L.  Freilinger,  1906 10  00 

Dr.  Leo  Karlinsky,  1906 20  00 

Dr.  J.  F.  Hawkins,  IQ06 25  00 

Dr.  Richard  C.  Hume,  1906 10  00 

Dr.  Frank  S.  Lynn,  1907 25  00 

Dr.  T.  H.  Legg,  1907 5  00 

Dr.  Albert  H.  Carroll,  1907 25  00 

Dr.  Edgar  S.  Perkins,  1907 25  00 

Dr.  W.  Cuthbert  Lyon,  1907 5  00 

Dr.  Thomas  H.  Phillips,  1908 25  00 

Dr.  J.  N.  Osborn,  1909 5  00 

Dr.  E.  H.  Kloman,  1910 25  00 

Terra  Mariae,  191 1 3  5° 

Latin- American  Club.   1912 25  00 

Total $9630  50 

Additions  for  the  month.  $185. 


ITEMS 

Profs.  Randolph  Winslow  and  R.  Dorsey 
Coale  attended  the  recent  meeting  of  the  Associa- 
tion of  American  Medical  Colleges  held  at  Chi- 
cago. Dr.  Winslow  was  elected  a  member  of  the 
Executive  Council  of  the  association  for  the  com- 
i n i> -  two  years. 


Dr.  A.  W.  Valentine,  class  of  1904.  of  606 
North  Carolina  avenue  S.  E..  Washington,  D.  C, 
writes  as  follows : 

"Enclosed  find  check  in  payment  of  bill.  1  'In 
hope  that  everything  is  progressing  satisfactorily 


in  putting  the  University  of  Maryland  upon  an 
everlasting  foundation.  Not  much  enthusiasm 
over  here;  wish  you  could  send  a  few  spellbinders 
over  to  wake  'em  up." 


Prof.  R.  Dorsey  Coale  is  in  receipt  of  the  fol- 
lowing letter  : 

"My  Dear  Dean — It  gives  me  great  pleasure  to 
convey  to  you  the  wishes  of  the  'Latin-American 
Club'  for  the  rapid  and  complete  success  of  the 
noble  work  already  begun  for  the  endowment  of 
the  pathological  chair  of  the  University. 

"This  work  will  undoubtedly  place  our  institu- 
tion on  an  equal  footing  with  the  most  modern 
universities  of  today.  Toward  this  end  the  mem- 
bers of  this  club  send  their  small  contribution  of 
$25,  and  hope  in  the  future  to  be  able  to  do  more 
for  our  Alma  Mater,  conjointly  and  individually. 
"Sincerely  yours. 

"Andreas  G.  Martin. 

"Class  of  1912." 


"U  e  would  be  pleased  if  some  of  our  readers 
could  give  us  the  addresses  of  the  following 
alumni :  Dr.  Howard  Steele  Holloway,  class  of 
1903,  who  was  for  a  time  in  Jacksonville,  Fla. ; 
Dr.  Roscoe  C.  Carnall,  class  of  1905,  formerly 
located  in  Wavcrly  Mills,  S.  C. ;  Dr.  Alexander  R. 
Mackenzie,  class  of  1910,  who  was  at  Sparrows 
Point  and  later  at  Blakeley,  W.  Va. ;  Dr.  Alvin 
("lay  McCall.  class  of  1910,  formerly  of  Folkstone, 
N.  C. ;  Dr.  Eugene  B.  Howie,  class  of  1910,  of 
North  Carolina ;  Dr.  Max  Joseph  Fiery,  class  of 
iqio,  and  Dr.  Frank  Paul  Fiery  of  the  same  class; 
Dr.  Lafayette  Lake,  class  of  1906,  recently  located 
in  Jackson,  La. 


Dr.  Albert  J.  Underbill,  of  the  Walbert  Apart- 
ments, assistant  in  the  genito-urinary  department 
at  the  University  of  Maryland,  begs  to  announce 
that  in  future  he  will  limit  his  practice  to  the 
treatment  of  genito-urinary  diseases. 


Dr.  Charles  I.  Stotlemyer,  class  of  1802.  is  lo- 
cated at  Hagerstown,  Ind. 


Dr.  Robert  Parke  Bay,  class  of  1905,  has  been 
appointed  visiting  surgeon  to  Mount  Street  Hos- 
pital, Baltimore :  Dr.  E.  H.  Kloman.  class  of  >•  • 
visiting  gynecologist;  Dr.  Hoaglaml  Cook  Davis, 


i6 


THE    HOSPITAL    BULLETIN 


class  of  [902,  visiting  laryngologist ;  Dr.  C.  XV. 
Mitchell,  class  of  1881,  visiting  physician;  Dr. 
Claude  C.  Smink,  class  of  1909,  visiting  physician. 


Report  of  cases  entering  the  dispensary 
ments  of  the  University  Hospital  for  J 
1912  : 

DISPENSARY. 

New.  Old. 

Surgical   157  399 

Medical  109  236 

Genito-urinary  56  242 

Eye  and  ear 54  78 

Tuberculosis 39  56 

Ni  ise  and  throat 36  63 

Children 28  52 

Stomach 26  52 

Nervous 12  84 

Gynecological 46  79 

Skin '    26  36 

Orthopedic 2  4 

Rectal  3  14 

Total 594  1305 

X-ray,  60  cases.  Laboratory. 


depart- 
anuary, 


Total. 
456 
345 
298 

132 

95 
99 
80 
78 
96 

1 -'5 

62 

6 

17 


1889 


Dr.  Dempsey  William  Snuffer,  class  of  1906, 

leckley,  W.  \'a..  writes:    "I'm  always  glad  to 

pay  for  The  Bulletin,  as  well  as   0  receive  it. 

It  keeps  me  well  informed  as  to  the  workings  of 

the  University." 


Dr.  Louis  YVinfield  Kohn,  class  of  iqto,  is  lo- 
cated at  429  Wyoming  avenue,  Scranton,  Pa. 


Dr.  Frank  Oldham  Miller,  class  of  1902,  of 
Ellicott  City,  Md.,  writes  that  "The  Bulletin 
is  my  only  means  of  keeping  track  of  former 
classmates  and  their  whereabouts." 


Dr.  Thomas  B.  Owings,  class  of  1852,  of  Elli- 
cott City,  Md.,  one  of  the  oldest  alumni  of  the 
University,  has  retired  from  active  practice  dur- 
ing the  past  \ear. 


Dr.  William  Emrich,  class  of  11)02,  js  physician 

to  the  Maderia  Mamore  Railroad  at  Porto  Bello, 

miles  from  the  mouth  of  the  Amaz&n,  Brazil. 


Miss  Emily  L.  Ely.  University  Hospital  Train- 
ing School  for  Nurses,  class  of  1909.  and  Mis- 


Elizabeth  Getzendanner,   of  the  same  class,   are 
both  nursing  in  Jacksonville,  Fla. 


Dr.  James  Madison  Lynch,  class  of  1904,  an- 
nounces that  on  January  22,  1912,  he  opened 
offices  at  6  and  8  Dehumor  Building,  Asheville. 
N.  C,  for  the  practice  of  general  surgery. 


Dr.  Oakey  S.  Gribble,  class  of  1905,  was  a  re- 
cent visitor  to  the  University  Hospital.  Dr.  Grib- 
ble has  been  wintering  in  the  South. 


Dr.  Charles  Augustus  Overman,  class  of  1903, 
has  forsaken  medicine  to  enter  upon  the  study  of 
law,  and  is  now  an  intermediate  in  the  law  school 
of  the  University  of  Marvland. 


Dr.  Compton  Riely,  class  of  1897,  has  been  ap- 
pointed a  member  of  the  visiting  staff  to  the 
Church  I  [ome  and  Infirmary.  Dr.  Riely  special- 
izes in  orthopedic  surgery. 


Dr.  Edward  E.  Lamkin,  class  of  1898.  who  has 
been  confined  to  the  University  Hospital  with  a 
fractured  arm,  which  he  had  plated,  has  suffi- 
ciently recovered  to  return  home. 


Miss  Anna  S.  Grubbs,  University  Hospital 
Training  School  for  Nurses,  class  of  1911,  has 
joined  the  staff  of  visiting  nurses,  ami  will  work 
in  the  Hampden  District. 


Dr.  John  Wilson  MacConnell,  class  of  1907.  of 
Davidson,  N.  C,  writes  as  follows: 

''January  25.  1912. 
"I  take  pleasure  in  paying  my  subscription  to 
The  Bulletin,  for  I  would  not  like  to  miss  a 
number.  It  keeps  me  in  touch  with  the  Maryland 
men  as  no  other  publication  could.  All  goes  well 
with  us  here.  As  you  know,  I  am  physician  to 
Davidson  College  and  locum  tenens  professor  of 
biology,  and  have  been  for  the  past  three  years. 
1  am  hoping  that  a  regular  professor  will  be 
elected  soon  so  that  I  may  give  all  my  time  to  my 
medical  work.  A  good  many  of  our  graduates 
go  to  the  University  of  Maryland.  In  all  the  de- 
partments now  at  Maryland  we  have  over  a  dozen 
men  from  Davidson,  and  at  Hopkins  we  have 
eight  in  the  Medical  School.  I  am  anxious  to  see 
Maryland  raise  the  standard  to  two  vcars  of  col- 


THE    HOSPITAL    BULLETIN 


17 


lege  work  as  a  minimum  entrance  requirement. 
The  course  as  now  given  is  all  right,  but  with 
advanced  entrance  requirements  the  Students 
could  cover  more  ground  and  assimilate  more 
rapidly  the  teachings  of  the  professors.  No 
school  lias  a  more  able  faculty  than  that  at  Marx- 
land  now,  and  though  we  often  say  'there  were 
giants  in  those  days,'  it  can  he  safely  said  also 
thai  'thou  dost  not  inquire  wisely  when  thou  say- 
est  that  Eormer  times  were  better  than  these,'  for 
.Maryland  is  better  today  than  ever  and  has 
greater  promise  for  a  glorious  future. 

"I  would  like  to  get  in  touch  with  some  of  the 
alumni  who  will  go  abroad  this  summer.  I  want 
to  visit  the  European  clinics,  and  would  much  pre- 
fer having  a  companion. 

"With  all  good  wishes,  I  am, 
"Sincerely. 

"John  W.  MacConnell." 


Dr.  Joseph  Blum,  class  of  1885,  has  retired 
from  a  practice  covering  a  period  of  27  years,  and 
will  make  his  future  home  in  Xew  York,  after  a 
residence  of  50  years  in  Baltimore. 

Dr.  Blum  leaves  Baltimore  with  many  regrets, 
conspicuous  among  these  his  severance  of  ties 
with  the  members  of  the  medical  profession,  but 
these  regrets  will  be  appeased  by  recollections  of 
the  most  pleasant  relations  that  have  always  ob- 
tained between  his  medical  friends  and  himself. 

Dr.  Blum  takes  advantage  of  these  columns  in 
bidding  farewell  to  the  members  of  the  medical 
profession  of  this  city. 


The  Randolph  Winslow  Surgical  Society  has 
been  formed  by  35  University  students,  23 
seniors  and  12  juniors,  the  object  being  to  pro- 
mote closer  relationship  among  the  students  of 
the  medical  department.  The  organization  has 
the  worthy  aim  of  promoting  in  the  hearts  of  its 
members  a  deep  sensibility  of  their  debt  to  their 
Alma  Mater. 

The  officers,  all  members  of  the  senior  class, 
are:  Henderson  Irwin,  president;  H.  A.  Bishop, 
vice-president;  Michael  Yinciguerra,  secretary; 
E.  P.  Kolb,  treasurer,  and  R.  E.  Abell,  historian. 

The  honorary  members  are  Professors  Ran- 
dolph Winslow,  J.  Holmes  Smith,  Arthur  M. 
Shipley,  Frank  Martin,  St.  Clair  Spruil.  J.  \Y. 
Holland  and  Nathan  Winslow:  Drs.  W.  T.  Cole- 


man. Robert  I'.  Bay,  Frank  S.  Lynn,  Frank  J. 
Kirby.  I 'age  Edmunds,  J.  Holmes  Smith.  Jr.,  and 
J.  A.  Tompkins. 

The  movement  which  resulted  in  the  formation 
of  the  societ)  was  Mailed  hy  Mr.  Irwin,  its  first 
president.  (  >n  the  committee  that  assisted  him  in 
formulating  plans  for  its  organization  were 
Messrs.  Abell,  Bishop,  Cochran,  Sellers  and 
Tullidee. 


Dr.  B.  Merrill  Hopkinson,  class  of  1SS5,  has 
been  appointed  for  the  twenty-third  consecutive 
year  president  of  the  Baltimore  Athletic  Club. 


Dr.  J.  Dougal  Bissell,  class  of  [888,  of  305  W. 
81st  street,  Xew  York,  has  been  elected  profe 
and  surgeon  to  the  Woman's  Hospital  in  Xew 
York.  He  was  formerly  assistant  to  Professor 
Cleveland,  and  was  advanced  upon  the  retirement 
of  Dr.  Bache  Emmett. 


The  schedule  for  the  University  of  Maryland 
baseball  team,  C.  Harry  Stevens,  manager,  for 
the  coming  season  is  as  follows: 

March  20 — Navy,  at  Annapolis. 

March  2- — Washington  College,  at  Chester- 
town. 

March  30 — Western  Maryland  College,  at 
Westminster. 

April  2 — Mount  St.  Mary's  College,  at  Em- 
mitsburg,  Md. 

April  6 — Dickinson  College,  at  Carlisle,  1'a. 

April  10 — Mount  St.  Joseph's  College,  at  Balti- 
more. 

April  13 — St.  John's  College,  at  Annapolis. 

April  17 — Rock  Hill  College,  at  Baltimore. 

April  20 — Randolph-Macon  College,  at  Ash- 
land, Va. 

April  22 — Fredericksburg  College,  at  Freder- 
icksburg. Va. 

April  27 — Pending. 

April  30 — Pennsylvania  State  College,  at  State 
College,  Pa. 

May  1 — Pending  with  Ursinus  College. 

May  4 — Baltimore  Medical  College,  at  Haiti- 
more. 

May  7 — Seton  Hall  College,  at  South  Orange, 
N.J. 


Dr.  Baird  U.  Brooks,  class  of  1905,  of  West 
Durham,  X.  C,  is  a  patient  at  the  Union  Prot- 


iS 


THE   HOSPITAL   BULLETIN 


estant  Infirmary,  where  he  will  be  operated  on 
by  Dr.  John  M.  T.  Finney. 


UNDERGRADUATES'  NOTES 


Under  the  Supervision  of  E.  A.  Loo  per. 


Dr.  J-  Righton  Robertson,  class  of  10,10,  an- 
nounces the  opening  of  his  office  in  the  Miller 
Walker  Building,  Augusta,  da.,  March  1,  191 2. 


The  basketball  team  has  closed  its  season. 
Following  is  an  account  of  receipts  and  expendi- 
tures lor  the  season : 

Expenditures. 

Incidental    expenses $38  32 

I  'riming — posters,    etc 9  00 

Equipment,    suits,    etc 70  OO 

Expenses  of  team  to  other  schools 287  39 

Total    expenses ?-P4  71 

Receipts. 

From  games  : 

From  Maryland  Medical  College $10  00 

From  Columbia  University 5°  °° 

From  City  College  of  New  York 55  oo 

From  Maryland  Medical  College 9  00 

From  Loyola  College 10  50 

From    Catholic   University   game 2000 

From  Georgetown  game 20  00 

From  Swarthmore  game 84 

From  Mt.  St.  Mary's  game 5  65 

From  Mt.  St.  Joseph's  game 4  85 

Refund  traveling  expenses 140  43 

Total    receipts $326  27 

( !i  1st  f(  ir  year $7n  44 


The  theater  benefit  given  on  February  7  at  the 
New  Academy  of  Music  for  the  benefit  of  the 
track  team  was  fairly  successful,  though  as  yet 
about  $70  worth  of  tickets  are  out  for  which  no 
returns  have  been  made  to  the  treasurer  of  the 
Alumni  Athletic  Association.  The  expenses  were 
as  follows : 

Printing  and  postage  of  ticket- $27  01 

Paid   Academy   of   Music 158   75 

Total $186  66 

Received  Erom  theater  tickets $249  50 

Part  of  the  sum  received,  however,  was  do- 
nated by  persons   who  did  not  use  the  theater 

ticket-. 


The  Athletic  Association  is  certainlv  to  be  com- 
mended upon  the  progress  it  has  made  in  the  short 
time  since  its  organization  at  the  beginning  of 
the  school  year.  The  students  are  becoming 
more  and  more  interested  in  its  maintenance,  and 
display  much  enthusiasm  at  each  athletic  meet. 
It  seems  unnecessary  to  prophesy  that  this  will 
undoubtedly  be  the  most  potent  factor  in  stimu- 
lating greater  class  spirit  among  the  student-. 

An  interesting  field  meet  was  held  January  i~ 
between  the  University  and  the  Cross  Country 
Club  in  the  Fifth  Regiment  Armory,  in  which  the 
University  boys  made  a  very  creditable  showing, 
taking  off  a  number  of  the  honors.  Timanus,  of 
the  sophomore  class,  proved  himself  quite  an 
athlete,  obtaining  the  highest  number  of  indi- 
vidual points,  winning  third  place  in  the  50-yard 
hurdle  and  second  place  in  the  shot  put.  Porter 
and  Shriver  of  the  freshman  class  also  won  hon- 
ors, Shriver  winning  the  16-pound  shot  put,  and 
Dorter  second  place  in  the  pole  vault. 

It  has  been  proven  that  the  University  contains 
quite  a  number  of  good  athletes  who  are  only 
handicapped  by  lack  of  proper  training,  which 
they  have  been  unable  to  obtain  during  the  year 
on  account  of  the  proper  facilities  and  the  lack  of 
time.  However,  they  have  always  shown  them- 
selves to  be  good  sportsmen,  and  have  sustained 
the  reputation  of  always  playing  fair  and  honest 
games. 

*  *  ■':■ 

A  benefit  performance  was  given  at  the  Acad- 
emy Wednesday,  February  7.  to  increase  the  ath- 
letic fund.  Most  of  the  professors  and  students 
at  the  University  attended.  Quite  a  nice  sum  was 
realized,  which  will  greatly  enlarge  the  equipment 
for  the  coming  year. 

:;:  $  :- 

Quite  a  number  of  the  senior  students  of  the 
University  intend  taking  the  competitive  exami- 
nations at  the  various  hospitals  in  the  city.  The 
University  men  always  show  up  well  in  these  ex- 
aminations, the  class  of  1911  being  represented 
by  interne-  in  the  principal  hospitals  of  the  city, 
having  five  of  its  members  at  Bayview.  one  at  St. 
Joseph's,   one  at  the  Church  Home,   two  at  the 


THE    HOSPITAL    BULLETIN 


19 


Hebrew  Hospital,  one  at  Eudowood  and  one  at 
Kernan's,  besides  the  appointments  at  the  Uni- 
versity I  [1  ispital. 

:;;  :[:  '■',: 

The  senior  students  have  been  greatly  inter- 
ested in  the  practical  clinics  given  at  the  different 
hospitals  under  the  direction  of  professors  of  the 
various  departments.  The  class  is  divided  into 
sections  to  meet  Dr.  Hiram  Woods  at  the  Presby- 
terian Eye  and  Ear  Hospital  on  diseases  of  the 
eyi  and  ear,  Dr.  Irving  Spear  at  Bayview  Insane 
Asylum  on  mental  diseases,  Dr.  R.  Tunstall  Tay- 
lor at  Kernan's  Hospital  for  Crippled  Children 
on  orthopedic  surgery  and  Dr.  John  R.  Winslow 
in  the  dispensary  of  the  University  Hospital  on 
diseases  of  the  nose  and  throat. 


FRATERNITIES. 

The  members  of  the  Chi  Teta  Chi  Fraternity 
entertained  with  an  informal  smoker  at  their 
Chapter  House  Saturday  evening,  January  2~ . 

The  Xu  Sigma  Xu  Fraternity  gave  their  an- 
nual fraternity  dance  at  Albaugh's,  Wednesday, 
January  31. 

On  Friday  evening,  February  9,  the  Phi  Sigma 
Kappa  Fraternity  entertained  with  a  tea  party. 
which  was  followed  by  a  dance,  at  their  Chapter 
House  "11  Park  avenue. 


BIRTHS 


Mr.  and  Mrs.  Joseph  Wright  of  Easton,  Md., 
are  receiving  congratulations  upon  the  birth  of  a 
son.  Mrs.  Wright  was  formerly  Miss  Ann  Eliz- 
abeth Chapman,  University  Hospital  Training 
School  fur  Nurses,  class  of  1906. 


On  February  5,  1912,  Addison  Clarke,  son  of 
Dr.  and  Mrs.  Sydenham  Rush  Clarke.  Dr. 
Clarke  is  a  member  of  the  class  of  1905. 


MARRIAGES 


Dr.  Napoleon  Bryan  Stewart,  class  of  1910, 
was  married  to  Miss  Edna  May  Revell  in  Tren- 
ton, X.  J.,  November  29,  1911.  The  marriage 
was  announced  at  the  annual  banquet  of  the  Phi 
Sigma  Kappa  Fraternity  and  came  as  a  great  sur- 
prise to  Dr.  Stewart's  friends.  The  couple,  aided 
by  Dr.  Ralph  C.  P.  Truitt,  class  of   1910,  were 


married  by  the  Mayor  of  Trenton,  the  parents  of 
both  having  full  knowledge  of  the  marriage  and 
plans.  Dr.  Stewart  is  the  son  of  the  late  Dr. 
Stewart  of  Delta,  Pa.,  and  Mrs.  Stewart  is  the 
daughter  of  Air.  and  Mrs.  Frank  S.  Revell  of 
Anne  Arundel  county. 


Dr.  Vernon  Francis  Kelly,  class  of  1904,  of 
3705  Falls  road,  Baltimore,  was  married  to  -Mis^ 
Laura  E.  H.  Spangler,  daughter  of  Mr.  Charles 
W.  Spangler  at  noon  Thursday,  March  7,  1912, 
at  the  residence  of  the  bride.  Liberty  Heights 
avenue,  Forest  Park,  the  Rev.  Dr.  George  1\. 
Crose  of  Grace  M.  E.  Church,  Baltimore,  per- 
forming the  ceremony.  The  bride  wore  a  blue- 
broadcloth  traveling  suit,  with  hat  to  match,  and 
a  corsage  boucjuet  of  violets  and  orchids.  The 
house  was  decorated  with  palms  and  pink  roses. 
The  couple,  after  a  trip  North,  will  reside  at  3705 
Falls  road. 


Dr.  Arthur  Edward  Ewens,  class  of  1904,  of 
Atlantic  City,  N.  J.,  was  married  to  Miss  Flor- 
ence Lane  Johnson,  daughter  of  Mr.  and  Mrs. 
Edward  Stockton  Johnson,  of  Atlantic  City,  on 
Tuesday,  February  27,  1912.  The  couple  will 
reside  at  the  Le  Grand  Apartments.  Dr.  Ewens 
was  well  known  at  the  University  and  was  very 
popular  with  his  class.  He  was  so  unfortunate 
as  to  lose  his  mother,  Mrs.  ITenrietta  Hill  Ewens. 
who  died  in  Baltimore  during  the  latter  part  of 
January. 


DEATHS 

Dr.  Gilbert  C.  Greenway,  class  of  1868,  died 
at  his  home.  118  Wilberforce  avenue.  Hoi 
Springs,  Arkansas.  Januarv  19,  1912,  aged  70 
years.     Dr.  Greenway  was  a  native  of  Virginia. 


Dr.  James  S.  Lovell  Muscey,  class  of  1891,  of 
Tearisburg,  Va.,  died  at  Pembroke,  Ya.,  Decem- 
ber 29,  7911,  as  the  result  of  a  carriage  accident, 
aged  45  years. 


Dr.  Thomas  Robert  Dougher.  class  of  1900.  of 
Avoca,  Pa.,  a  member  of  the  staff  of  Pittston 
Hospital,  died  at  his  home  February  16,  1912, 
from  meningitis  following  an  attack  of  pneu- 
monia, aged  64  years. 


Dr.  George  Edward  Hurst  Harmon.  C  S.  X. 


20 


THE    HOSPITAL   BULLETIN 


i  retired),  class  of  1872,  died  at  the  residence  of 
his  aunts,  Mrs.  M.  E.  Harmon  and  Miss  Sarah  A. 
Hurst,  at  Cambridge,  Md.,  March  5,  1912,  of  a 
complication  of  diseases.  Dr.  Harmon  was  the 
son  of  the  late  Dr.  George  and  Mrs.  Mary  Eliza- 
beth Hurst  Harmon.  After  graduation  Dr.  Har- 
mon practiced  medicine  for  a  short  time,  then 
entered  the  medical  corps  of  the  Navy,  filling  sev- 
eral important  posts.  At  the  time  of  his  retire- 
ment, in  1910,  Dr.  Harmon  was  in  command  of 
the  Navy  Medical  School  Hospital,  Washington, 
D.  C.  Besides  his  aunts,  Dr.  Harmon  is  sur- 
vived by  a  sister  and  an  uncle. 


Dr.  Norton  Royce  Hotchkiss,  class  of  1891,  died 
at  his  residence  in  New  Haven,  Conn.,  January 
30,  /I912,  of  leukemia,  from  which  he  had  suf- 
fered for  years.  Dr.  Hotchkiss  was  41  years  of 
age.  lie  was  born  at  Fort  Mill,  S.  C,  August 
23,  1870,  and  was  educated  in  public  schools,  later 
studying  medicine  at  the  South  Carolina  Medical 
College  and  the  University  of  Maryland.  He  set- 
tled in  New  Haven  the  year  of  his  graduation, 
and  had  been  most  successful. 

Dr.  Hotchkiss  was  a  member  of  the  American 
Medical  Association  and  the  Association  of  Mili- 
tary Surgeons  of  the  United  States,  and  presi- 
dent of  the  New  Haven  Medical  Association.  He 
served  under  Governor  Woodruff  (1897)  as  sur- 
geon-general of  the  State.  He  was  a  director  of 
the  Elm  City  Hospital  and  an  attending  surgeon 
at  St.  Raphael's  Hospital.  Dr.  Hotchkiss  was 
interested  in  fraternal  organizations,  and  at  the 
time  of  his  death  was  a  thirty-second  degree  Ma- 
son. He  is  survived  by  his  widow,  formerly  Miss 
Lucy  E.  Belk  of  Portsmouth,  Ya.,  and  three 
children. 


Dr.  Peter  H.  Latham,  class  of  1876,  died  at  his 
home  in  Weatherly,  Pa.,  January  2^,,  from  dia- 
betes, aged  62.  Dr.  Latham  was  coroner  of  Car- 
bon county,  Pennsylvania,  and  for  many  years 
visiting  physician  at  the  Laurytown  Almshouse 
and  local  surgeon  for  the  Lehigh  Yallev  Railroad. 


Dr.  Mathias  Adolph  Edward  Borck,  class  of 
1863,  died  at  his  home  in  St.  Louis  January  20, 
1912,  from  senile  debility,  aged  yy  years.  Dr. 
Borck  was  an  acting  assistant  surgeon  in  the 
United  States  Army,  and  later  assistant  surgeon 
of  the  Tenth  Maryland  Volunteer  Infantry  and 


Third  Maryland  Volunteer  Cavalry  during  the 
Civil  War.  He  took  a  course  and  graduated  at 
Washington  University,  St.  Louis,  Mo.,  in  1874, 
and  was  professor  of  surgery  in  the  St.  Louis 
College  for  Medical  Practitioners,  of  which  he 
was  one  of  the  founders. 


Dr.  Nathan  D.  Tobey,  class  of  1863.  died  at  his 
home  in  A'aughan,  N.  M.,  January  10.  1912.  aged 
74  years.  Dr.  Tobey  was  a  member  of  the 
Golden  Belt  Medical  Society  and  formerly  presi- 
dent of  the  Salina  (Kans.)  Medical  Association. 
Dr.  Tobey  practiced  medicine  in  Salina.  Kans.. 
for  25  years.  For  three  years  he  was  editor  of 
the  Salina  Herald. 


Dr.  John  L.  Blair,  class  of  1868,  died   at  his 
home  in  Mercersburg,   Pa.,  December  31.   1912, 


aged  66  years. 


Dr.  John  Fletcher  Powell,  class  of  1853.  of  304 
West  Lanvale  street,  Baltimore,  died  at  his  home 
February  15,  1912,  from  senile  debility.  Dr. 
Powell  was  born  in  Baltimore,  and  received  his 
early  education  in  private  schools  and  at  Phillips' 
Academy,  Andover,  Mass. 

During  the  yellow-fever  epidemic  in  Norfolk 
and  Portsmouth  in  1855,  in  which  31  physicians, 
natives  and  volunteers  died,  Dr.  Powell  was  ap- 
pointed by  this  city  as  one  of  the  health  officers 
for  the  Old  Bay  Line  steamers.  For  three 
months  he  traveled  on  the  steamers,  exercising 
quarantine  supervision.  • 

He  spent  one-third  of  the  time  ashore  aiding 
the  sick  and  studying  the  disease.  As  physician 
of  the  Baltimore  City  Jail  Dr.  Powell  during  the 
Civil  War  had  more  than  900  Confederate  prison- 
ers under  his  care  there.  For  more  than  half  a 
century  he  was  a  member  of  Concordia  Lodge  of 
Masons.  He  was  also  a  member  for  55  years  of 
the  Medical  and  Chirurgical  Faculty  of  Mary- 
land. 

He  is  survived  by  a  widow,  who  was  Miss  Alice 
A.  Tilyard,  and  five  children. 


Dr.  Julius  Levin,  class  of  1905,  formerly  of 
Chicago,  was  found  dead  in  his  apartments  in 
Johnstown,  Pa.,  February  T2,  1912.  from  acci- 
dental asphyxiation  by  carbon  monoxid.  aged  ^2 
years. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 
PRICE    $1.00    Pi;n     YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  608  Professional  Building,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.    VIII 


BALTIMORE,  MD.,  APRIL  IS,   1912. 


No.  2 


PRACTICAL  EXPERIENCE  WITH  SPINAL 
ANESTHESIA.* 


By  Louis  Winfield  Kohn,  M.D.,  1910, 
Interne  Stale  Hospital,  March,  1911. 


By  spinal,  subarachnoid  or  lumbar  anesthesia 

is  understood  a  method  of  rendering  portions  of 

the  animal   organism  insensible  by  tbe  injection 

of  local  anesthetics  into  the  subarachnoid  space 

if  the  spinal  canal. 

Some  of  the  anesthetics  employed  for  this  pur- 
pose are  cocaine,  tropococaine,  novocaine  and 
stovaine.  During  my  connection  with  this  hos- 
pital it  has  been  my  fortune  to  witness,  and  at  the 
same  time  study,  this  mode  of  anesthetization,  the 
immediate  effects  and  results  produced.  What 
l  nowledge  I  have  acquired  in  this  type  of  anes- 
thesia has  been  gained  during  my  service  mi- 
ller the  staff  surgeon.  Dr.  E.  G.  Roos,  who  has 
employed  this  means  of  anesthetization  in  con- 
junction with  80  or  more  operative  cases. 

I  will  now  endeavor  to  relate  some  of  our  prac- 
tical experiences  with  this  form  of  anesthesia, 
hoping  at  the  same  time  to  make  such  as  interest- 
ing as  possible.  The  anesthetic  of  choice  with 
Dr.  Roos  is  stovaine,  because  of  its  comparative 
harmlessness  if  properly  employed.  The  solution 
employed  is  from  Billon  of  Paris,  and  contains  4 
per  cent,  stovaine.  The  dose  varies  according 
to  the  condition  of  the  individuals  and  their  ap- 
parent ages.  The  dose  commonly  emploved  by 
Dr.  Ron-,  i-  from  4  to  6  cgm.,  although  as  low  as 
1  '•  _  cgm.  and  as  high  as  7  cgm.  have  been  used. 
From  our  experiences  here  certain  operation- 
have  been  performed  where  either  the  anesthesia 
was  incomplete  or  not  of  such  lasting  effect  as  to 
allow  completion  of  operation.  In  such  a  case  a 
general  anesthetic  has  been  resorted  to.  To  over 
come  any  such  occurrence  the  patient  is  always 

*Read  before   LKckawanna  County  Medical   Society  Novei  i- 
ber  :\  inn.  al  Scranton,  Pa. 


ordered  to  be  prepared  for  general  anesthesia  in 
conjunction  with  other  preparation-. 

The  material  required  for  the  injection  of  the 
anesthetic  is  a-  follows:  First,  a  wire  probe  with 
a  piece  of  sterile  cotton  wound  on  one  end.  This 
is  clipped  into  carbolic-acid  solution  (05  per 
cent.),  and  the  spot  where  the  needle  is  to  be  in- 
troduced is  touched  with  this  carbolic  applicator. 
This  spot  is  thus  rendered  antiseptic  and  some- 
what anesthetic.  This  carbolic  spot  is  allowed  to 
evaporate  to  dryness  before  puncturing,  thus  in- 
suring no  entrance  of  carbolic  acid  into  the  spinal 
canal.  Second,  a  cannula,  long  and  thin,  beveled 
at  its  pointy  end  expressly  made  for  this  purposi  , 
hollow  and  of  small  caliber  throughout  its  length. 
Third,  a  mandrel  or  puncturing  rod,  which  fits 
into  the  cannula  and  is  withdrawn  as  soon  as  you 
have  determined  that  the  subarachnoid  space  is 
near.  Fourth,  a  glass  syringe  properly  graduated. 
The  one  employed  by  Dr.  Roos  is  of  the  Luer 
type  and  of  2  c.  c.  volume.  Fifth,  the  stovaine 
solution,  which  come-  in  vials  of  2  c.  c.  volume; 
each  e.  c.  of  the  stovaine  solution  contains  4  cgm. 
of  the  active  principle  stovaine.  All  of  this  mate- 
rial should  be  kept  separate  and  away  from  the 
other  instruments.  They  should  be  sterilized  by 
boiling  in  distilled  water. 

The  preparation  of  the  patient  will  now  be  dis- 
cussed: — The  nurse  is  instructed  to  prepare  the 
patient  for  operation,  for  general  anesthesia  and 
for  spinal  anesthesia.  In  preparing  for  operation 
the  proposed  site  of  operation  is  thoroughly 
cleansed  in  accordance  with  the  hospital  method. 
viz..  tincture  of  green  soap  and  water,  followed 
successively  with  alcohol,  ether  and  bichloride  of 
mercury  solution  (  1-5000).  Then  aseptic  dress- 
ings are  applied.  By  preparation  for  general  an- 
esthesia is  meant  the  withdrawal  of  all  nourish- 
ment for  a  period  of  at  least  12  hours  before  op- 
eration, the  administration  of  calomel,  grs.  2.  in 
divided  doses  of  gr.  '  1  every  quarter  hour,  begun 
at  least  18  hour-  before  operation,  and  the  ad- 
ministration of  MgSo4  sol.,   1  oz..  an  hour  after 


22 


THE   HOSPITAL   BULLETIN 


all  calomel  has  been  given.  A  simple  enema  is 
also  given  at  least  six  hours  before  operation  for 
the  purpose  of  evacuating  the  lower  bowel  and 
avoiding  unnecessary  defecation  during  the  oper- 
ative procedure.  \Ye  next  resort  to  the  prepara- 
tion for  spinal  anesthesia,  and  this  is  accomplished 
by  thoroughly  cleansing  and  aseptically  preparing 
the  entire  back  of  the  patient  I  between  parallel 
lines,  one  running  through  the  seventh  cervical 
spinous  process  above  and  the  other  through  the 
lower  border  of  the  sacrum  below  as  well  as  be- 
tween the  midaxillary  lines  on  the  sides)  as  for 
operation  described  above.  It  has  also  been  a 
custom  in  the  majority  of  our  cases  to  administer 
two  hours  before  operation  by  hypodermic  injec- 
tion morphia  sulphate,  gr.  %,  and  hyoscine  hydro- 
bromide,  gr.  i-ioo,  for  the  purpose  of  slightly 
depressing  the  cerebral  cortex,  thus  bringing 
about  a  certain  degree  of  hypnosis,  which  is  of 
advantage  in  that  it  materially  aids  in  the  produc- 
tion of  a  quicker  anesthetic  effect  as  well  as  the 
avoidance  of  any  ill  psychic  influences.  The  pa- 
tient is  ordered  to  the  operating-room  at  a  stated 
time.  The  surgeon  and  his  assistants  prepare  for 
the  operation  and  the  anesthetic  administration. 
Thorough  asepsis  on  the  part  of  the  surgeon,  his 
assistants  and  nurses  are  insisted  upon  and  rig- 
idly observed.  The  instruments  are  all  sterilized 
by  boiling  in  distilled  water. 

Preparation  for  the  Administration  of  the  An- 
esthetic.— The  patient  is  placed  upon  the  operat- 
ing table,  but  instructed  to  sit  up  across  the  width 
of  the  table  with  the  buttocks  resting  near  the 
extreme  edge  of  the  one  lengthy  side,  whilst  the 
legs  will  hang  from  the  knees  down  on  the  other 
lengthy  side  of  the  table.  The  patient  is  also  in- 
structed to  fold  the  arms  and  bow  the  back  so  as 
t<>  bring  about  a  strong  lumbar  flexion.  This 
flexion  increases  the  height  of  each  interspinous 
space  and  facilitates  the  proper  introduction  of 
the  needle.  An  assistant  at  the  same  time,  by 
passing  an  arm  from  behind  forward  around  the 
patient's  neck,  greatly  supports  and  steadies  the 
patient.  The  dressings  (as  a  result  of  previous 
preparation )  are  next  removed  and  the  back  ex- 
posed.  The  approximate  site  for  injection  is 
again  antisepticized  with  alcohol  and  bichloride 
of  mercury  solution,  followed  by  washing  with 
sterile  water  and  then  dried.  A  sterile  towel  is 
then  employed,  the  upper  edge  of  which  is  applied 
crosswise  over  the  back  so  as  to  coincide  with  the 
upper  border  of  the  iliac  crests.     We  now  know 


that  the  interspinous  depression  found  near  the 
junction  of  this  towel  with  the  spinal  column  is 
between  the  fourth  and  fifth  lumbar  vertebrae. 
Having  once  found  this  intervertebral  space,  we 
next  ascertain  the  point  for  injection.  This  point 
is  about  i  mm.  to  the  right  or  left  of  the  midline. 
Dr.  Roos  usually  enters  between  the  second  and 
third  lumbar  vertebrae,  although  he  has  injected 
into  all  the  interspaces  between  the  twelfth  dorsal 
and  fourth  lumbar  vertebrae.  In  operations  upon 
the  gall-bladder  or  stomach  he  has  injected  be- 
tween the  twelfth  dorsal  and  first  lumbar  verte- 
brae. These  points  are  easily  located  upon  inspec- 
tion and  palpation. 

The  Mode  of  Injection. — Having  located  the 
point  for  entrance,  it  is  touched  up  with  the  car- 
bolic-acid applicator.  As  soon  as  this  carbolic 
spot  has  evaporated  to  dryness  the  top  of  the  vial 
(containing  the  stovaine)  is  next  broken  and  the 
glass  syringe  filled  with  stovaine.  The  cannula 
(  with  the  puncturing  rod  or  mandrel  within  its 
hollow  viscus)  is  then  introduced  directly  for- 
ward at  a  right  angle  to  the  skin.  As  soon  as  you 
feel  that  resistance  is  overcome  you  have  pierced 
the  interspinal  ligament,  and  now  it  behooves  you 
to  draw  out  the  puncturing  rod.  If  you  should 
have  entered  the  subarachnoid  space  spinal  fluid 
will  drip  out  of  the  cannula;  but  if  not,  then  push 
the  cannula  slightly  forward,  and  after  having 
overcome  a  slight  resistance,  due  to  the  dura  ma- 
ter and  arachnoid  membranes,  spinal  fluid  will 
begin  to  drip  forth.  An  assistant  is  then  in- 
structed, after  having  allowed  a  few  c.  c.  of  spinal 
fluid  to  drip  out,  to  place  a  finger  over  the  mouth 
of  the  cannula.  Then  the  surgeon  arranges  his 
dose  in  the  glass  syringe  and  connects  the  syringe 
to  the  mouth  of  the  cannula  (at  the  same  time 
steadving  the  cannula).  He  then  draws  out  some 
spinal  fluid  so  as  to  dilute  the  stovaine  solution, 
and  then  injects  the  entire  contents  of  the  syringe 
into  the  canal.  A  piece  of  aseptic  gauze  is  placed 
over  the  point  of  injection  as  soon  as  the  cannula 
is  withdrawn.  The  patient  is  then  slowly  placed 
upon  the  back  and  a  pillow  is  placed  under  the 
head. 

While  waiting  for  anesthesia  to  appear  all 
preparations  for  operation  are  being  completed. 
A  sterile  sheet  is  also  interposed  between  the 
head  and  body,  so  as  to  cut  oft"  from  the  patient 
any  possible  view  of  the  operation.  The  ears  are 
stuffed  with  cotton,  so  as  to  avoid  hearing  the 
clanging    of    instruments,    verbal    remarks,    etc. 


THE   HOSPITAL   BULLETIN 


23 


The  eyes  are  covered  with  a  towel,  so  as  to  cut 
off  from  view  anything  of  occurrence  in  the  oper- 
ating-room that  may  have  a  depressing  effect 
upon  the  patient.  A  small  pledgel  of  cotton  |  well 
spread  out)  is  stuck  on  to  the  tip  of  the  nose, 
overhanging  the  anterior  nares.  This  piece  of 
cotton  will  serve  as  a  safeguard  to  the  respira- 
tions, indicating  inspiration  and  expiration  by  its 
up  and  down  movement,  as  well  as  the  nature  of 
the  respirations,  whether  -hallow  or  deep  and 
whither  diaphragmatic  or  due  only  to  the  acces- 
sory muscles.  As  soon  as  anesthesia  is  recognized 
the  operation  is  begun. 

In  sonic  eases  the  desired  anesthesia  comes  on 
immediately  after  injection.  In  other  eases  it 
may  lie  necessary  to  raise  the  head  end  of  the 
table  so  as  to  hasten  on  the  anesthesia.  This  i> 
due  to  the  fact  that  the  stovaine  solution  is  of  a 
lower  speeific  gravity  than  the  cerebro-spinal 
fluid,  and  just  as  soon  as  the  head  end  of  the  table 
i-  elevated,  just  so  soon  does  the  spinal  or  heavier 
fluid  buoy  the  stovaine  or  lighter  fluid  upward, 
and  in  consequence  we  have  our  quicker  anes- 
thetic effect.  At  times,  again,  when  we  have  a 
sudden  too  profound  anesthesia  as  well  as  hyp- 
nosis, we  can  lower  the  head  end  of  the  table, 
thus  causing  the  stovaine  to  be  buoyed  in  the  op- 
posite direction,  viz.,  toward  the  lower  end  of  the 
spinal  canal.  The  result  is  that  the  anesthetic 
influence  will  be  confined  to  the  lower  spinal  cen- 
ters only.  In  the  majority  of  our  cases  the  anes- 
thetic influence  made  itself  manifest  during  a 
periofl  varying  from  one  to  four  minutes.  Four 
minutes  were  usually  given  as  the  allotted  time 
for  the  production  of  anesthesia  t(  >  its  full  extent. 
In  order  to  know  whether  anesthesia  has  occurred 
one  must  compare  the  sensibility  of  a  place  out- 
side of  the  anesthetic  zone  with  that  of  a  place 
where  anesthesia  is  expected.  This  is  done  by 
pinching.  If  a  non-anesthetized  area  is  pinched, 
the  patient  will  give  vent  to  an  expression  of 
pain,  or,  if  the  countenance  is  watched,  will  wince. 
<  In  the  other  hand,  by  pinching  the  tissues  below 
the  level  of  injection,  viz.,  perineum,  genitals, 
thighs,  etc.,  they  will  seem  to  have  lost  a  certain 
degree  of  sensibility.  The  anesthesia  seems  to 
extend  from  below  upward  as  high  as  the  umbili- 
cus, and  often  times  higher.  Cases  were  noted 
where  upon  pinching  the  anterior  surface  of  the 
chest  as  high  as  the  second  rib  no  sensibility  was 
experienced.  Within  four  minutes,  as  stated 
above,  complete  anesthesia  is  usually  encountered. 
The  senses  of  pain,  touch  and  posture  have  disap- 


peared, and  instead  the  patient  only  experiences 
;i  feeling  of  numbness  in  the  legs.  Together 
with  this,  motor  paralysis  has  occurred  in  the  ma- 
jority of  ease-.  The  patient  could  not  move  the 
limbs;  reflexes  were  abolished  and  the  character- 
istic ankle-drop  was  apparent — in  general,  a  pic- 
ture of  a  flaccid  paralysis.  Then,  again,  there 
were  cases  where  insensibility  was  most  promi- 
nent and  motor  paralysis  not  so  apparent.  In- 
stead, only  a  generalized  weakness  occurred, 
nevertheless  concomitant  with  thorough  muscular 
relaxation.  The  efficiency  of  our  anesthesia  was 
easily  demonstrated  upon  stretching  the  sphincter- 
am  muscles  and  dilating  the  cervix  uteri.  The 
abdominal  muscles,  as  well  as  the  intestinal  mus- 
culature, in  nearly  all  of  our  cases  underwent 
thorough  relaxation.  The  patients  absolutely 
have  no  feeling  below  the  [joint  of  injection,  and 
the  limbs  appear  to  them  as  dead.  We  have  had 
certain  patients  upon  whom,  after  waiting  for 
15  minutes,  the  stovaine  produced  no  appreciative 
anesthetic  effect.  In  these  cases  chloroform  an- 
esthesia was  resorted  to,  and  it  is  surprising  to 
know  how  small  an  amount  of  chloroform  was 
required  throughout  the  operation.  It  also  ap- 
peared in  the  majority  of  these  cases  to  Dr.  Roos 
and  those  present  that  extraordinary  excellent 
muscular  relaxation  occurred.  In  certain  cases 
where  numerous  operations  were  performed  upon 
the  same  person,  and  where  the  effect  of  the  spinal 
anesthetic  wore  oft,  chloroform  was  resorted  to 
and  a  very  small  amount  was  required  in  each 
case.  The  effect  of  the  stovaine  in  our  cases 
lasted  no  less  than  one  hour;  on  the  other  hand, 
the  effects  wore  off  in  periods  varying  from  one 
to  five  hours. 

During  the  operation  an  assistant  remains  at 
the  head  of  the  table.  He  encourages  the  patient, 
watches  the  pulse,  respirations  and  general  ap- 
pearance of  the  patient,  as  well  as  complications 
should  they  arise.  If  the  condition  of  the  patient 
permits,  water  or  lemonade  may  be  given  to 
quench  thirst.  In  one  case  of  a  man  operated 
upon  for  hemorrhoids  there  was  a  great  desire 
for  smoking.  1  lis  wish  was  gratified  by  the  pres- 
entation of  a  lighted  cigar,  which  the  patient  en- 
joyed throughout  the  operation,  none  the  worse 
for  bis  experience,  liis  last  words  upon  leaving 
the  hospital  were:  "Isn't  it  great  stuff?"  In  an- 
other case  of  a  young  woman,  upon  whom  a  bi- 
lateral salpingectomy  and  appendectomy  had  been 
performed,  it  was  hardly  possible  just  after  the 
operation  to  convince  her  that  she  had  been  oper- 


24 


THE    HOSPITAL   BULLETIN 


ated  upon,  although  she  remembered  the  operat-  gastric   carcinoma,   where   a   gastroenterostomy 

ing-room,  with  its  other  attending  incidents  that  was  performed,  and  operable  gastric  carcinoma, 

dav.    It  is  nevertheless  true  that  in  some  cases  the  where  a  partial  gastrectomy  and  gastro-duoden- 

senses  are  more  or  less  obtunded,  whilst  in  others  ostomy  was  done, 

no  such  effect  is  at  all  noted.  The  accompanying  table  will  give  you  an  idea 

During  the  anesthesia  it  has  occurred  at  times  of  some  work  done  under  this  form  of  anesthesia. 
that  the  patient  became  nauseated  and  vomited.  Besides  the  cases  named,  numerous  other  opera- 
By  lowering  the  patient's  head  somewhat  this  tions  upon  patients  of  all  ages  and  in  worse  con- 
nausea  has  been  overcome.     Aromatic  spirits  of  ditions  were  performed. 

ammonia  has  also  been  efficiently  employed  for  Another  good  feature  which  may  be  attributed 

this  purpose.    At  times  also  the  patient  turns  pale  to   the    spinal   anesthetic   is   the   change   it    has 

and  perspires  profusely,  while  the  pulse  occasion-  brought  about  in  the  time  required  for  the  per- 

ally  also,  as  in  general  anesthesia,  loses  some  of  formance  of  our  operations.     The  surgeon,  the 

its   better  characteristics,   and    for   this  purpose  assistants  and  nurses  must  be  on  the  alert  in  order 

such    stimulation   as    is    found   necessary    is   em-  to  make  quick  time  and  finish  before  the  effect  of 

ployed.     No  other  complications  or   sequelae  of  our  anesthetic  is  lost.    Dr.  Roos  was  exceedingly 

account  occurred  in  any  of  our  cases,  but.  on  the  elated  at  the  finish  of  his  service  because  of  the 

contrary,  T  dare  say,  nearly  every  case  recovered  rapidity  with  which  he  was  forced  to  operate,  as 

with  remarkable  rapidity.  well  as  the  excellent  results  he  attained.     He  is 

It  was  plainly  seen  that  nearly  every  ease  en-  still  employing  stovaine  in  all  of  his  private  cases 
joyed  a  more  speedy  immediate  recovery  than  wherever  possible,  and  maintains  that  if  spinal 
those  operated  upon  under  general  anesthesia,  anesthesia  can  be  recommended  fur  operative 
The  patients  were  not  so  depressed  just  after  cases  with  pulmonary  tuberculosis,  heart  and  kid- 
operation  as  were  the  other  eases.  There  was  ney  lesions,  as  well  as  such  depressing  conditions 
no  nausea  or  vomiting  after  operation.  What  did  contraindicating  general  anesthesia,  it  certainly 
prevail  in  certain  cases  fur  a  few  hours  was  that  can  be  recommended  for  sound,  healthy  individ- 
dead  feeling  in  the  legs,  which  gradually  disap-  uals.  His  future  ideas  are  to  employ  the  smallest 
peared.  The  patients  were  immediately  put  on  efficient  dose,  injected  into  the  lumbar  portion  of 
liquid  or  soft  diet,  as  was  consistent  with  the  case,  the   spinal    canal,    at    the    same   time   observing 

We  have  tried  this  form  of  anesthesia  on  an  proper  technique  and  asepsis.      In  conclusion.  I 

excellent  variety  of  eases,  some  of  which  doubt-  must    say    that    our   results    during   the   past    10 

less  would  not  have  fared  so  well  with  a  general  months    with   this    form  of  anesthesia   has  been 

anesthetic.    For  examples  may  lie  mentioned  trail-  gratifying. 

matie   amputations   and   gunshot    wounds   of  the  Up  to  date.  Dr.  E.  (1.  Roos  at  the  State  Hospi- 

abdomen,  who  came  into  the  hospital  shocked  and  tal   has    operated   upon   221    eases  under   spinal 

apparently  pulseless :  also  cases  such  as  inoperable  anesthesia. 

Name.                  '■■_                Operation.                                                                          Stovaine.  Time. 

Mrs.  E.  H.          90  vis.     Nailing  a  fractured  femur 6      cgm.  i'j  hours. 

)Irs  II.    S.  50      "       Amputating  leg  above  ankle.     Setting  fracture  femur  of 

1  ither  leg    7  I  hour. 

Mrs.  M.   C         36     "      Resection  head  of  femur 6  2  hours  5  min. 

Mrs.  S.   M.         7N     "      Plaster  cast  to  fractured  femur sA  1  hour. 

J.  F.            20     "       Plaiting  fractured  femur 1  i'j  hrs. -f- chlor.    V2   oz. 

Mr<.  I-;.    Mel).   60     "      Partial  gastrectomy  and  gastro-duodenostomy 5        "  2'4  hrs.  +  chlor.  %  oz. 

for  Yj,  hrs. 

M.  A.          3     "      Prolapse  rectum 2  54    hr. -{-}£   oz.    chlor. 

for  i  _.  hr. 

F.  W.        17     "      Bilateral  salpingectomy  and  appendectomy 5  1  hour  io  min. 

W.  M.       05             Prostatectomy,  suprapubic 6  1  hour. 

Mr.    W.   1'.         27     "      Section   for  ruptured  ectopic  and  dil.  and  curett.,,  Bab- 
cock  repair  and  amput.  cervix C<  1    hr.    25    min.  +  l    oz. 

chlor.  =  'j  hr. 
Mr.     B.   1  >.  2.?      "       Dil.  and  curett.  and  section   for  bilateral   salpingectomy. 

hysteropexy,  bilateral  oophorectomy 5         "        1  hr.     10    min.  +  l     oz. 

chlor.  for  '  -j  hr. 

G.  S.  14  mos.  Herniotomy  and  appendectomy 1  A  and  A>  oz.  chlor.  —  to   v> 

min. 

C.  M.         13  yrs.    Gunshot  wound,  abdomen 4  35  min. 

J.  E.  13     "      Curett.  necrosed  tibia '. 4  10  min. 


THl    HOSPITAL   BULLETIN 


25 


IMS  H  )RV  (  IF  THE  ANAT(  IMISTS  OF  THE 
UNIVERSITY  OF  MARYLAND.* 


Bj   Ernest  S.  Bulluck,  M.D., 
Wilmington,  N.  C. 


Alter  the  close  of  the  Revolutionary  War  the 
colonists  turned  their  attention  to  affairs  at  home 
with  such  success  that  our  country  grew  in  trade 
and  population  for  the  first  20  years  with  sur- 
prising rapidity.  At  the  close  of  this  period  one 
finds  the  people  of  Baltimore  calling  for  increased 
efficiency  of  its  physicians  and  a  separation  of  the 
worthy  from  the  unworthy  practitioner.  ■ 

I  leading  this  movement  we  find  Dr.  Wiesen- 
thal,  who  advocated  the  formation  of  a  medical 
society,  ft  was  after  his  death  that  the  proposed 
organization  was  completed  by  his  son  Andrew, 
and  beginning  as  the  "Medical  Society  of  Balti- 
more," it  later  evolved  into  the  present  Medico- 
Chirurgical  Faculty  of  Maryland. 

Under  the  auspices  of  this  society  in  the  year 
1789  dissection  was  attempted.  The  body  of  a 
criminal  was  procured,  but  the  populace  inter- 
fered, took  possession  of  the  body  and  put  an  end 
to  the  project.  Despite  this  discouragement,  Dr. 
Andrew  Wiesenthal  lectured  throughout  the  year 
to  a  class  of  15  students  with  such  success  that 
the  formation  of  a  medical  school  was  proposed 
for  the  following  session.  The  proposed  school, 
however,  was  never  inaugurated,  so  the  doctor 
continued  his  private  course. 

About  this  time  Dr.  John  Beale  Davidge  moved 
to  Baltimore,  ire  was  an  Annapolis  boy  who, 
having  graduated  from  St.  John's  College,  had 
spent  several  years  studying  anatomv  at  the  Uni- 
versity of  Edinburgh  and  later  graduated  at  Glas- 
gow University. 

He  came  to  the  city  when  a  youth  with  train- 
ing and  ambition,  and  after  six  years  of  practice 
started  a  private  course  of  lectures  on  anatomy. 
For  five  years  he  continued  this  course  of  instruc- 
tion. In  1807,  having  drawn  about  him  Drs. 
James  Cocke  and  John  Shaw,  he  founded  the 
"College  of  Medicine  of  Maryland,"  which  was 
later  to  become  the  Medical  Department  of  the 
University  of  Maryland.  Dr.  Davidge,  to  aug- 
ment the  teaching  facilities  in  this  department  of 
the  new  school,  built  at  his  own  expense  a  small 


•Throughout  this  sketch  I  am  constantly  indebted  to  the 
historical  researches  of  Eugene  F.  Cordell,  Professor  of  II is- 
lory  of  Medicine  in  the  University  Of  Maryland. 


anatomical  theater  and  procured  a  subject  for 
dissection,  but  the  fact  became  known;  a  crowd 
gathered,  which  grew  into  a  mob,  who  proceeded 
to  demolish  the  building  and  destroy  its  contents. 

It  was  now  deemed  best  to  procure  land  on  the 
outskirts  of  the  city,  and  to  obtain  legal  protec- 
tion they  applied  to  the  Legislature  for  a  charter 
for  a  medical  college.  The  petition  was  favored 
and  the  charter  granted  on  December  18,  1807, 
there  being  only  four  other  medical  schools  in 
this  country  at  that  time. 

Under  the  new  charter  the  teaching  of  anatomy 
was  divided  between  Davidge  and  Cocke.  Lec- 
tures began  at  once,  delivered  at  the  homes  of  the 
teachers.  During  this  year  the  class  numbered 
seven  only,  and  there  were  no  dissections.  The 
following  year  the  lectures  were  delivered  in  a 
dilapidated  old  schoolhouse  on  the  southwest  cor- 
ner of  Fayette  street  and  McClellan's  alley, 
which  was  for  four  years  the  home  of  the  Med- 
ical Department  of  the  University  of  Maryland. 
Professor  Cocke  was  an  able  anatomist,  having 
had  the  advantage  of  instruction  under  Sir  Ashley 
Cooper.  He  was  also  a  good  lecturer,  and  in  1812 
was  given  full  charge  of  the  department  of 
anatomy.     . 

At  this  time,  the  money  having  been  previously 
raised  by  lottery,  the  present  medical  building, 
corner  Greene  and  Lombard  streets,  was  begun, 
to  be  completed  the  coming  session. 

The  session  of  1813  found  the  school  in  the 
new  building,  and  Dr.  Cocke  was  to  have  deliv- 
ered the  first  lecture,  but  he  fell  ill  and  died  at  the 
hour  appointed  for  the  lecture.  He  was  the 
school's  first  secretary,  and  the  building,  in  which 
he  never  lectured,  owed  much  for  its  existence 
to  his  keen  business  intuition.  Dr.  Davidge 
taught  obstetrics  for  a  while,  but  he  again  as- 
sumed the  duties  of  anatomist. 

At  this  time  practical  anatomy  did  not  consti- 
tute a  prominent  part  of  the  course,  and  dissec- 
tion was  not  compulsory.  The  present  office  of 
the  dean  was  given  over  to  the  work,  as  the  second 
floor  of  the  building  was  not  completed.  There 
being  no  demonstrator  at  this  time,  the  room 
usually  fell  in  charge  of  the  most  zealous  student. 
Such  a  student  was  Godman  of  Annapolis,  and 
when,  in  1817,  Dr.  Davidge  was  confined  with  a 
broken  thigh,  Godman,  conscious  of  his  ability, 
rose  to  the  occasion  and  delivered  the  lectures 
with  such  enthusiasm,  mastery  of  words,  gifts  of 
speech  and  power  of  imparting  knowledge  that  he 


26 


THE    HOSPITAL   BULLETIN 


lent  new  interest  to  the  subject  and  completely 
won  the  admiration  of  his  fellow-students. 

At  the  end  of  his  course  he  wanted  to  stay  with 
the  school,  hut  she  offered  him  no  inducement, 
lie  then  made  his  home  in  the  country.  After  a 
few  years  he  founded  a  school  of  anatomy  in 
Philadelphia.  He  later  held  many  professorships 
ami  wrote  extensively  on  anatomical  and  other 
subjects,  and  although  his  final  attainment  was 
great,  it  was  without  connection  with  the  Cniver- 
sity,  who  lost  in  him  the  greatest  anatomist  of 
his  time. 

Some  years  later,  owing  to  the  resignation  of 
Dr.  Gibson.  Dr.  Davidge  delivered  the  surgical 
lectures,  and  Dr.  William  Howard,  an  able  assist- 
ant,  was  appointed  to  help  in  the  anatomical  work. 
The  work  was  thus  divided  until  1S21).  when  Dr. 
Davidge  was  found  to  have  cancer  of  the  antrum 
of  Highmore.  The  course  of  the  disease  was 
very  painful  and  rapid,  and  he  was  soon  confined 
to  his  home. 

For  the  remainder  of  the  year  his  lectures  were 
delivered  by  Nathan  R.  Smith,  a  promising  young 
surgeon,  who  had  previously  taught  anatomy  in 
Jefferson  Medical  College.  For  the  coming  ses- 
sion Dr.  John  D.  Wells  was  elected.  He  taught 
for  one  year,  then  returned  to  his  home,  where  he 
later  died  of  tuberculosis. 

At  the  suggestion  of  Dr.  Wells  the  lectureship 
was  awarded  t'>  1  >r.  Benjamin  Lincoln  of  Burling- 
ton, Vt.,  whose  lectures  were  so  satisfactory  that 
at  the  end  of  the  year  the  full  professorship  was 
tendered  him,  but  he  firmly  refused,  and  returned 
to  the  enjoyment  of  his  home,  which  he  valued 
more  highly  than  professional  honors. 

In  1831  the  chair  was  filled  by  Dr.  Thomas  II. 
Wright  of  Baltimore,  a  prominent  and  able  phy- 
sician, but  not  particularly  interested  in  the  study 
of  anatomy.  He  proposed  that  a  Dr.  Turnbull 
be  appointed  to  assist  him.  Finding  that  the  fac- 
ulty had  not  acted  upon  his  suggestion,  he  imme- 
diately resigned.  During  the  same  year  the 
learned  Eli  Geddings  was  unanimously  elected  to 
that  chair,  which  he  held  for  five  years,  reflecting 
great  honor  upon  the  school.  His  resignation  was 
due  to  the  unsettled  conditions  in  regard  to  the 
State  control  of  the  institution. 

After  leaving  the  University  he  returned  to  his 
native  State  and  became  professor  of  surgery  in 
the  medical  College  of  Sentli  Carolina,  from 
which  school  he  had  obtained  his  degree  at  the 
close  of  its  first  session. 


In  1837,  following  Professor  Geddings,  the 
anatomical  department  again  fell  into  the  capable 
hands  of  Dr.  Nathan  R.  Smith.  After  teaching 
for  a  year  lie  resigned  and  left  the  University, 
but  the  duration  of  his  absence  was  not  long,  and; 
after  a  few  years  we  again  find  him  at  the  head 
of  the  department. 

Previous  to  this  time  Dr.  William  Nelson 
Baker,  whose  father  was  a  prominent  member  of 
the  school's  faculty,  was  conducting  a  private 
course  in  anatomy  in  the  building  in  Cider  alley, 
just  behind  the  University.  Flis  class  had  been 
large  and  his  ability  recognized,  so  he  was  elected 
to  the  position  vacated  by  Dr.  Smith.  Fie  con- 
ducted the  department  with  vigor  and  great  suc- 
cess until  1841,  when  he  died,  having  just  attained 
the  age  of  30.  He  is  represented  as  having  been 
a  man  of  great  personal  beauty  and  attractions, 
talented  and  with  every  promise  of  a  brilliant 
future  as  a  lecturer,  anatomist  and  surgeon. 

The  chair  of  anatomy  was  again  unoccupied, 
and  Dr.  Miltenberger.  "the  venerable  old  uncle" 
of  the  present  professor  of  obstetrics,  was  sent 
North  to  hear  the  lectures  of  Dr.  Joseph  Roby  of 
Boston.  So  favorable  was  the  report  of  Dr.  Mil- 
tenberger  that  Dr.  Roby  was  immediately  elected 
to  the  vacancy.  After  the  assumption  of  his  du- 
ties Dr.  Roby's  electors  were  more  than  satisfied. 
He  worked  from  9  to  3  o'clock  daily,  and  was 
very  particular  about  his  dissections,  censuring  the 
smallest  nick  of  the  knife  and  insisting  that  the 
linen  should  be  perfectly  clean  and  white.  During 
his  administration  dissection  became  compulsory 
(1848),  there  at  this  time  being  no  American 
school  that  demanded  dissection  of  its  students. 

This  marked  a  new  era  in  the  teaching  of  anat- 
omy, and  was  the  beginning  of  the  method  that 
is  destined  to  supplant  the  lecture.  Indeed,  the 
practical  value  of  dissection  seemed  to  have  been 
realized  at  an  early  date,  for  we  find  advertised 
in  the  catalogues  "abundant  dissecting  material." 
which  notice  has  been  recopied  even  to  the  pres- 
ent day. 

During  this  same  year  illuminating  gas  was 
introduced  into  the  dissecting  hall  "at  great  ex- 
pense," and  offered  the  opportunity  to  work  at 
night. 

After  15  years  of  service,  during  which  time 
anatomical  study  at  the  University  reached  such 
importance  that  it  commanded  honorable  recog- 
nition from  all  the  great  medical  schools  of  our 
country,  Dr.  Robv's  health  began  to  fail,  and  from 


THE   HOSPITAL   BULLETIN 


27 


then  until  two  years  later,  when  he  died  of  tuber- 
culosis, his  lectures  were  delivered  by  the  ever- 
efficient  Dr.  Nathan  R.  Smith. 

The  year  i860  opens  with  I  )r.  William  A.  1  lam- 
mond,  U.  S.  A.,  as  professor  of  anatomy. 
Through  his  efforts  microscopes  were  placed  in 
the  museum  and  one  of  the  largest  collections  of 
slides  in  the  country  was  at  the  command  of  the 
students. 

Ihe  University  of  Maryland  prides  itself  upon 
being  the  first  school  in  America  to  teach  micro- 
scopical anatomy,  so  another  onward  stride  was 
made  to  a  more  perfect  comprehension  of  this 
great  suhject. 

1  [ammond  withdrew  from  the  University  at  the 
beginning  of  his  second  year  and  the  lectureship 
again  fell  to  the  "ever  present  help  in  time  of 
need."  Nathan  R.  Smith,  who  completed  the  term 
and  turned  the  department,  in  1862,  over  to  Chris- 
topher Johnson.  This  new  teacher  was  an  ar- 
dent student  of  histology  and  a  skillful  microscop- 
ist.  and  his  work  did  much  to  promote  the  growth 
of  this  new  phase  of  anatomy. 

Previous  to  1866  the  professors  of  anatomy  had 
also  taught  physiology,  hut  now  the  anatomist 
was  relieved  of  this  branch ;  physiology  being 
grouped  under  one  lectureship  with  hygiene  and 
general  path  1I1  igy. 

In  1869,  after  the  retirement  of  our  so  many 
times  professor  of  anatomy,  Nathan  R.  Smith, 
Christopher  Johnson  was  elected  professor  of 
surgery.  The  vacancy  was  now  awarded  to 
Francis  T.  Miles,  a  South  Carolinian,  who  had 
spent  about  20  years  at  various  other  schools  in 
anatomical  work. 

A  few  years  later  the  course  of  instruction  was 
extended  from  four  to  five  months.  Miles  was  an 
eloquent  and  attractive  lecturer  and  continued 
in  the  department  until  eleven  years  later,  when 
he  was  transferred  to  the  department  of  phys- 
iology, where  he  served  with  great  distinction. 

Dr.  J.  Edwin  Michael,  having  spent  six  vears 
as  demonstrator  of  anatomy,  was  awarded  the 
professorship  in  1880.  During  the  following  year 
the  course  was  again  extended,  this  time  to  five 
and  one-half  months.  Again  in  1890  the  addi- 
tion of  one  month  was  made  to  the  course.  At 
the  same  time.  April.  1890,  Michael  was  trans- 
ferred to  the  chair  of  obstetrics.  His  previous 
position  was  then  awarded  to  Randolph  Winslow 
of  North  Carolina,  who  had  since  his  graduation. 
t6  years  before,  pursued  the  subject   with  such 


fervent  zeal  and  masterly  understanding  as  to 
clearly  demonstrate  his  fitness  for  the  position. 

During  the  same  year  the  course  which  had 
previously  been  two  years,  was  extended  to  three-. 
The  resignation  of  Louis  McLane  Tiffany  was 
si  11  hi  to  follow  and  the  school  must  have  another 
professor  of  surgery.  The  material  was  reviewed 
and.  as  had  ever  been  the  case,  the  best  surgeon 
was  found  in  the  dissecting  hall.  Another  anato- 
mist was  transferred.  Dr.  J.  Holmes  Smith,  then 
demonstrator  of  anatomy,  was  made  its  professor. 

The  course  was  now  made  to  cover  seven  and 
one-half  months  and  later  extended  to  its  present 
length.  During  the  nine  years  that  he  has  occu- 
pied the  chair  of  anatomy  he  has  greatly  enlarged 
the  scope  of  its  practical  work.  As  a  lecturer,  he 
is  unassuming,  clear,  concise,  separating  the 
wheat  from  the  chaff  and  deply  impressing  all 
essentials,  and  it  is  hoped  that  his  term  of  service 
may  he  as  long  as  it  has  been  successful.  For  the 
vacancy  that  must  some  day  occur  the  university 
will  not  find  herself  unprepared,  fur  she  has  in 
her  present  demonstrator,  Dr.  Holland,  a  man 
of  rare  ability  as  a  dissector  with  God-given 
genius  for  teaching.  With  the  few  words  that 
denote  wisdom  and  the  generous  manliness  that 
encourages  the  weary  and  inspires  the  vigorous, 
he  rules  by  his  presence  and  receives  co-opera- 
tion anil  admiration  in  return. 

The  anatomical  department  gives  to  the  student 
the  most  useful  knowledge  that  he  gains.  It 
teaches  the  fundamentals  upon  which  all  future 
medical  training  must  he  based,  so  what  could 
be  more  fitting  and  proper  than  that  it  should 
have  mothered  our  school  from  the  beginning. 
The  other  departments  have  drained  it  of  its 
good  men  as  they  arose. 

The  chair  of  surgery  owes  its  nearly  every 
occupant  to  the  dissecting  hall.  The  school  of 
anatomy  has  ever  been  the  backbone  of  the  uni- 
versity, and  who  would  not  cherish  the  tender 
memory  of  our  greatest  department  and  those 
who  made  it? 


Dr.  William  L.  Rodman,  professor  of  surgery 
in  the  Medico-Chirurgical  College  of  Philadel- 
phia, lectured  in  the  University  on  "Surgery  of 
the  Stomach  and  Breast"  on  Friday  and  Satur- 
day, March  22  and  2,}.  Dr.  Rodman  was  the 
guest  of  Prof.  Randolph  Winslow  during  his  stay 
in  this  city. 


28 


THE   HOSPITAL   BULLETIN 


REPORT  OF  A  CASE  OF  ABIOTROPHIC 
CORTICAL  DEGENERATION  WITH 
SECTION  OF  POSTERIOR  SPINAL 
ROOTS  FOR  RELIEF  OF  SYMPTOMS. 


By  C.  W.  Rauseneach  and  W.  M.  Scott, 
Class  of  1912. 


Name — O.  L. 
Address — Baltimore. 
Age — Seventeen  years. 
Sex— Male. 

Occupation — None. 

Social  Condition — Single. 

Complaint — "Spasms  of  arms  and  legs." 

Family  History — Father  living  and  well. 
Mother  living  but  in  the  Springfield  Hospital 
because  of  insanity.  Two  brothers  and  two  sis- 
ters living  and  well ;  no  nervous  trouble.  One 
sister  died  at  the  age  of  seven ;  cause,  membran- 
ous croup.  Mother's  form  of  nervous  trouble 
"was  sent  to  the  above-mentioned  hospital  be- 
cause of  spells  of  nervousness  coming  on  several 
times  during  the  day  and  night,  evidenced  by  sud- 
den outbreaks  of  temper,  with  crying  for  about 
half  an  hour,  and  then  hysterical  laughter  for 
about  the  same  period  of  time.  Occasionally  she 
would  run  about  the  house,  but  never  injured  her- 
self, nor  was  she  ever  absolutely  unconscious. 
These  fits  would  usually  begin  after  some  minor 
favor  was  asked  of  her  or  whenever  she  became 
excited."  Family  history  is  negative  to  malig- 
nancy, tuberculosis  and  kidney  diseases. 

Past  History — At  the  age  of  ten  had  measles ; 
no  complications.  Negative  to  diphtheria,  scarlet 
fever,  pertussis,  chorea,  sore  throat,  rheuma- 
tism, typhoid,  malaria,  influenza,  pneumonia  and 
pleurisy.  Has  always  been  healthy,  but  was  de- 
livered by  instruments. 

Habits — Smokes  no  cigarettes,  cigars  or  pipe. 
Drinks  no  alcoholics  (father  is  a  wine  drinker, 
but  never  becomes  intoxicated).  Denies  ever 
having  masturbated.  Drinks  coffee  in  modera- 
tion. Has  regular  habits  as  to  sleep  and  meals, 
but  always  has  been  excitable. 

Present  Illness — Began  about  nine  years  ago. 
four  months  after  being  hit  in  left  eye  with  a 
baseball.  Began  soon  after  being  severely  pun- 
ished by  father,  who  first  noticed  a  twitching  and 
contraction  of  the  left  wrist  when  in  a  semi-flexed 
position.  This  soon  involved  the  entire  arm  and 
had  spastic  contractions  which  could  not  be  con- 
in  'lied.    In  a  short  time  the  ri^ht  leg  became  in- 


volved and  several  other  groups  of  muscles.  The 
contractions  occurred  mostly  in  the  flexors  and 
could  not  be  controlled,  and  they  became  worse,  so 
that  they  would  remain  flexed  for  a  short  time. 
Then  in  two  years  the  left  arm  became  involved 
and  in  another  year  the  left  leg,  but  the  involve- 
ment of  this  side  has  never  been  so  severe.  After 
a  time  the  erecti  muscles  became  involved  with 
these  contractions.  These  contractions  are  nor 
marked  at  night  when  asleep,  but  may  be  in- 
creased when  awake  by  excitement  or  other 
causes. 

Gastro-intcstinal  Tract — Some  indigestion 
after  meals  with  eructations  of  gas.  Somewhat 
constipated. 

Pulmonary  and  other  tracts  are  negative. 

LABORATORY  FINDINGS. 

Urine — Albumin  and  sugar  are  absent,  reac- 
tion acid,  specific  gravity  1032,  straw  color,  aro- 
matic odor,  some  sediment,  few  epithelial  cells 
and  hyaline  casts,  little  mucus  and  granular  de- 
bris. 

Blood — Leucocyte  count,  7200. 

Haemoglobin,  87  per  cent. 

Blood  pressure,  no. 

Three  Wassermans  made  and  all  proved  nega- 
tive. 

Physical  Examination — At  the  time  of  exami- 
nation patient,  a  white  boy,  17  years  old,  sitting 
in  a  semi-recumbent  position,  showing  no  evi- 
dence of  acute  pain,  but  having  numerous  vio- 
lent involuntary  contractions  of  his  extremities 
and  more  marked  on  his  right  side  and  suffering 
from  dyspnoea.  His  mentality  is  exceptionally 
good  and  his  intellectual  faculties  are  well  devel- 
oped. 

Head  of  medium  size,  covered  with  a  thick 
crop  of  black  hair,  no  areas  of  alopecia,  no  scars 
noted,  occipital  protuberance  prominent.  Eyes : 
The  right  eye  is  smaller  than  the  left,  pupils  are 
equal  and  somewhat  dilated,  react  normally  to 
light  and  accommodation,  field  of  vision  normal, 
ocular  motion  good,  sclera  of  a  pearly  hue.  con- 
junctiva somewhat  anaemic  with  tortuous  vessels, 
ocular  tension  normal.  Ears  are  large,  low  set.  no 
tophi,  nor  mastoid  or  accessorv  sinus  tenderness, 
no  discharge,  hearing  on  the  right  side  is  ob- 
tunded.  Nose  is  prominent  and  large,  cartila- 
genous  portion  is  slightly  displaced  to  the  right 
and  the  left  nostril   larger  than   the   right. 

Mouth — Palate  is  broad    and    slightly    dome- 


THE    HOSPITAL    BULLETIN 


29 


shaped,  mucous  membrane  is  anaemic,  tonsils  arc 
slightly  enlarged,  peritonsillar  ring  is  injected, 
pharynx  is  bathed  with  a  serous  secretion  from 
the  posterior  nares,  teeth  are  in  a  good  state  of 
preservation,  minis  firmly  adherent,  no  pyorrhoea. 
Tongue  protrudes  slightly  to  the  right  and  has 
a  fibrillary  tremor,  dorsum  is  of  a  good  color  and 
is  nut  coated. 

Neck  is  short,  well  rounded  and  developed. 
There  is  a  spasticity  of  sterno-cleido-mastoids  and 
especially  of  the  right :  no  tracheal  tug,  no  ab- 
normal pulsations,  submaxillary  glands  are  pal- 
pable  but  not  markedly  enlarged. 

Chest  is  markedly  distorted,  covered  with  heavy 
and  well-developed  muscles,  which  are  in  a  state 
of  constant  contraction,  there  is  a  marked  flar- 
ing outward  of  the  entire  costal  margin  on  both 
-ides,  causing  the  lower  opening  of  the  thorax 
to  lie  expanded  and  greatly  resembling-  a  much- 
exaggerated  Harrison  sulcus.  Costo-xiphoid  an- 
gle is  about  85  degrees,  no  scars  noted,  expan- 
sion equal  on  both  sides,  but  respirations  entirely 
of  a  thoracic  type,  which  is  greatly  impaired  by 
the  tonic  contractions  of  these  muscles,  frequently 
causing  dyspnoea.  After  deepest  inspiration  the 
chest  measures  71  cm.  and  after  the  fullest  expira- 
tion chest  measures  67  cm.  Palpation  of  the  chest 
no  friction  fremitus,  no  abnormal  pulsations  felt, 
tactile  fremitus  is  normal.  Percussion  of  the 
chest  normal  except  at  the  right  apex  where  per- 
cussion note  is  flattened.  Auscultation  of  the 
clu  st :  Breath  sounds  very  hard  to  ascertain  be- 
cause of  the  numerous  contractions  of  the  mus- 
cles, but  his  respiration  is  harsh,  somewhat  puerile 
in  character,  short  and  jerky. 

Spine — Xo  spinal  tenderness,  no  kyphosis  or 
other  abnormalities,  has  a  linear  scar  30  cm.  in 
length  and  beginning  at  the  fifth  dorsal  vertebrae 
and  extending  downward.  This  scar  is  due  to 
a  laminectomy.  All  the  muscles  of  the  back  are 
in  a  state  of  clonic  contractions. 

Heart — It  is  impossible  to  ascertain  the  exact 
condition  because  of  his  constant  involuntary 
movements.  The  heart  -sounds  are,  however, 
very  rapid  and  distant — no  murmurs  made  out. 

P.  M.  I.  is  neither  visible  nor  palpable.  Palpa- 
tion over  the  precordium  showed  no  distinct 
shock  nor  thrill. 

Liver — It  is  impossible  to  palpate  it  because  of 
rigidity  of  the  muscles  of  the  abdomen,  but  there 
are  no  areas  of  tenderness  over  it. 

Abdomen — Has  a  verv  flat  abdomen,  muscles 


are  very  well  nourished  and  hard  as  a  board  from 
their  tonic  contraction  and  especially  marked  on 
the  right  side.  There  are  no  areas  of  tender- 
ness. There  is  no  distention  of  the  abdomen 
nor  meteorism.  Because  of  abdominal  rigidity  it 
is  impossible  to  palpate  the  spleen  or  kidneys. 

Inguinal  glands  are  palpable  on  both  sides,  but 
not  markedly  enlarged,  there  is  no  phimosis,  para- 
phimosis, no  scars  and  genitalia  are  apparently 
normal. 

Lower  Extremities — Muscles  of  the  right  side 
are  somewhat  atrophied  and  in  a  state  of  tonic 
contraction  with  intermittent  clonic  contractions 
causing-  involuntary  and  inco-ordinate  movements 
of  the  leg.  The  tonic  contractions  of  the  muscles 
of  the  right  leg  produce  an  abduction  of  the  foot 
which  he  cannot  voluntarily  overcome.  No  scars 
noted,  joints  are  not  swollen,  inflamed  nor  ten- 
der, and  there  is  no  roughening  of  the  tibia.  Left 
leg :  There  is  a  marked  atrophy  of  the  muscles 
of  the  thigh  and  leg  and  they  are  not  in  a  state 
of  tonic  contraction  but  are  flaccid.  There  are  no 
joint  involvements,  no  scars,  foot  drop  is  pres- 
ent and  the  skin  is  loose  and  inelastic. 

Upper  Extremities — Well  developed,  muscles 
are  in  a  state  of  clonic  contraction  causing  a 
marked  extension  and  separation  of  the  fingers, 
which  also  have  athetoid  movements  and  espe- 
cially of  the  right.  No  scars,  glandular  enlarge- 
ments nor  joint  involvements.  Pulse  is  of  low- 
tension,  small  volume,  very  rapid  (150  per  min- 
ute), and  there  is  no  marked  fibrosis  of  the  ra- 
dial vessels. 

Neurological  Examination.  —  Patient's  intelli- 
gence very  well  developed,  talks  intelligently  on 
all  topics  of  the  day ;  speech,  apparently  no  evi- 
dence of  aphasia  or  of  articular  disturbances ;  rec- 
ognizes all  objects  well,  memorv  for  remote  and 
recent  events  is  exceptionally  good  :  at  present  has 
no  use  of  left  lower  limb;  no  evidence  of  hemi- 
plegia :  all  muscles  except  those  of  expression  and 
mastication  are  in  a  spastic  condition. 

Motor  Examination—  The  muscles  of  the  neck, 
shoulder  and  back  are  of  good  muscular  power. 
The  extensors  of  both  arms  and  flexor  group  of 
left  arm  possess  their  normal  muscular  power,  but 
the  flexors  of  the  right  arm  are  somewhat  weak- 
ened. Both  the  extensors  and  flexors  of  the  right 
forearm  are  also  weakened.  The  flexors  of  the 
left  thigh  are  paralyzed,  those  of  the  right  are 
weakened:  and  the  extensors  of  the  left  thigh 
have   also    partially   lost    their    normal   muscular 


30 


THE   HOSPITAL   BULLETIN 


power.  The  flexors  of  both  legs  and  the  extensor 
of  left  are  markedly  weakened.  There  is  a  weak- 
ening of  the  flexors  of  the  right  foot  and  the  ex- 
tensors of  the  left  foot,  and  a  paralysis  of  the 
flexors  of  the  left  foot  producing  a  foot  drop. 

Trophic  Disturbances  —  All  the  muscles  are 
somewhat  atrophied,  there  is  a  marked  atrophy 
of  those  of  the  left  limb.  Over  the  right  ichial 
tuberosity  there  is  a  small  decubital  ulceration 
about  the  size  of  a  penny. 

Abnormal  Movements — There  is  a  constant,  ir- 
regular, uncontrollable,  partly  atheoid,  partly 
choreiform  contraction  of  the  muscles  of  the  entire 
body  with  the  exception  of  those  of  mastication, 
expression  and  lower  left  extremity.  These  move- 
ments occur  both  during  rest  and  activity-.  Dur- 
ing -deep  the  inco-ordinate  contractions  cease  and 
the  muscles  are  somewhat  relaxed.  During  ex- 
citement the  contractions  become  most  violent, 
causing  profuse  perspiration,  tetanic  contractions 
of  respiratory  spinal  muscles,  causing  respectively 
dyspnoea  and  a  semi-opisthotonic  position.  At 
times  the  arms  may  be  violently  affected  with  lit- 
tle or  no  involvement  of  the  leg;  and  conversely 
the  legs  may  be  violently  affected  with  little  or  no 
involvement  of  the  arms. 

Co-ordination  of  Muscles — He  has  absolutely 
110  control  over  the  affected  muscles  and  attempts 
to  perform  actions  requiring  co-ordination  of 
these  muscles  exaggerate  the  passive  atheoid  and 
choreiform  contractions. 

Rcflc.vcs — The  abdominal,  cremasteric,  left 
plantar  and  left  Babinski  are  absent;  ;'.  e.,  they 
do  not  respond  at  all  to  stimuli.  The  left  ankle 
clonus  is  suggestive  and  the  right  is  positive. 
Right  Babinski  markedly  positive.  The  triceps 
reflexes  are  exaggerated ;  the  periosteo-radials, 
the  right  knee  and  tendo-achilles  are  not  obtain- 
able due  to  the  tonic  contractions  of  the  muscles 
concerned  in  these  reflexes ;  and  the  knee  and  ten- 
do-achilles of  left  limb  fail  to  react  to  stimuli. 
There  is  a  presumptively  positive  left  Kernig's 
sign,  which,  however,  is  in  all  probability  due  to 
an  atrophic  shortening  of  the  posterior  group  of 
muscles  of  the  thigh  which  are  the  flexors  of 
the  leg. 

Sensory  Examination — Muscular  and  pain 
senses  are  normal. 

Temperature  Sense — There  is  analgesia  over 
inguinal,  hypogastric,  lower  half  of  dorsal,  lum- 
bar and  sacral  regions  and  extending  over  the  but- 
tock.    There  is  decreased  perception  of  sensation 


over  right  leg,  left  thigh,  upper  half  of  anterior 
surface  of  left  leg.  Over  posterior  and  lower  half 
of  anterior  surface  of  left  leg  there  is  a  misinter- 
pretation of  temperature  sense  causing  feelings 
of  warmth  when  either  heat  or  cold  are  applied. 
There  is  also  complete  analgesia  of  entire  left 
foot. 

Tactile  Sense — There  is  complete  anaesthesia 
over  lower  inguinal,  and  hypogastric  regions, 
over  back  beginning  at  fifth  dorsal  vertebra,  ex- 
tending downward  to  buttock  and  outer  and  dor- 
sal surface  of  left  foot. 

Stereognostic  Sense  —  Apparently  normal. 
There  is  a  numbness,  paleness  and  coldness  of 
the  entire  left  limb. 

Cranial  Nerves — The  auditory  nerve  on  left 
side  is  somewhat  involved  causing  an  obtunding 
of  the  sense  of  hearing  in  left  ear.  There  is  an 
involvement  of  both  spinal  accessory  nerves,  espe- 
cially of  the  right,  causing  a  tonic  contraction  of 
the  trapezius  and  sterno-cleido-mastoid  most 
marked  in  the  latter  muscle.  Hypoglossal  is  in- 
volved, causing  the  tongue  to  protrude  slightly 
to  the  right  of  medium  line.  All  the  other  cra- 
nial nerves  are  normal. 


ITALIAN   SUPERSTITION  IN  REGARD 
TO  PLACENTA. 


By  Ejnar  Hansen,  M.D., 

New  York,  X.  Y. 


Dr.  J.  Johnson  of  Copenhagen  writes  in  Uge- 
skrift  for  Laeger  an  amusing  account  of  a  disgust- 
ing superstition  found  among  the  lower  classes 
in  Italy. 

In  1907  the  water  in  the  public  well  in  Maggi- 
one  became  so  bad  that  the  mayor  sent  samples  of 
it  to  Dr.  Bellucci,  professor  in  chemistry  in  Pe- 
rugia, asking  him  to  have  them  examined. 

The  examination  showed  that  the  water  was 
contaminated  by  organic  matter.  Dr.  Bellucci 
expressed  the  opinion  that  some  dead  animal  was 
at  the  bottom  of  the  well,  and  that  it.  would  be 
necessary  to  empty  and  thoroughly  cleanse  it. 
This  was  done.  No  animal  was  found,  but  the 
bottom  was  filled  to  a  height  of  four  to  five  feet 
with  numerous  clay  bowls,  carefully  bound  up, 
and  each  containing  a  decayed  mass,  which  on 
closer  examination  proved  to  be  human  placentae. 
These  were  so  numerous  that  Bellucci  found  the 
space  filled  by  them  measured  nearly  two  and  a 
half  cubic  yards.     By  questioning  a  number  of 


THE    HOSPITAL    BULLETIN 


3' 


the  inhabitants  he  found  that  the  throwing  of  the 
placentae  into  the  well  was  an  ancient  custom,  so 
strictly  kept  that  it  had  been  impossible  to  keep 
the  well  covered. 

This  discovery  started  Dr.  Bellucci  on  the  trail 
concerning  the  Italian  superstition  in  regard  to 
placenta  {vide  Archivia  per  I'antropologia  e  la 
Etnolpgia,  Vol.  XI),  and  he  found  that  in  the  pop- 
ular superstition  placenta  was  always  connected 
with  either  involution  of  uterus  or  lactation,  or 
both.  If  placenta  is  nut  promptly  expelled,  the 
magical  art  is  resorted  to. 

In  many  places  the  husband's  hat  is  placed  mi 
the  patient'.-  head  or  his  trousers  are  placed  on 
her  abdomen.  Still  better,  horseshoes  are  some- 
times used,  part  of  the  shoe  being  introduced  into 
the  vagina.  In  other  pari-  the  woman  must  blow 
into  a  bottle,  and  at  the  same  time  all  windows 
and  doors  must  be  kept  open,  otherwise  the  uterus 
will  not  retract. 

When  at  last  the  placenta  is  expelled,  it  must  be 
placed  in  a  bowl  underneath  the  bed  exactly  below 
the  -boulders  of  the  patient.  There  it  remain-  for 
three  days  until  the  flow  of  milk  has  started.  As 
soon  as  that  has  taken  place  the  placenta  i-  buried, 
sometimes  with  salt,  symbolic  of  sagacity,  or  with 
grain,  symbolic  of  richness. 

The  placenta  must  he  buried  in  a  moist  place, 
beneath  the  outlet  from  the  roof,  in  a  dunghill  or 
in  a  cemetery.  It  is  best  to  throw  it  into  a  spring 
or  a  well,  as  was  done  in  Maggione,  because  the 
moisture  of  the  burial  place  is  very  important  to 
the  lactation.  If  the  placenta  dries  up,  the  milk 
will  stop  ;  but,  on  the  other  hand,  the  action  of  the 
placenta  on  the  water  makes  it  lactiferous. 

Placenta  is  also  used  to  hasten  the  involution 
of  uterus,  and  is  then  placed  on  the  abdomen  of 
the  patient.  The  afterpains  are  alleviated  if  the 
patient  drinks  a  cup  of  soup  made  from  the  pla- 
centa, or  if  a  few  drops  of  blood  are  pressed  and 
mixed  with  the  yolk  of  an  egg  and  given  to  the 
woman. 

A  very  strange  custom  prevails  in  Sardinia.  If 
a  child  is  still-born,  the  navel  cord  is  not  cut,  but 
the  attendant  awaits  the  expelling  of  the  placenta. 
As  soon  as  it  arrives  it  is  placed  on  a  pan  and 
fried,  the  child  being  kept  close  beside  the  pan. 
The  hope  of  the  parents  and  the  attendants  is  that 
the  heat  will  drive  the  baby's  soul  into  the  body 
through  the  uncut  navel  cord,  and  that  the  child 
may  be  brought  to  life. 

Xew  York,  January,   1912. 


"PREVENTIVE  MEDICINE  AMONG  OUR 
YOUTH." 


By  C.  I''.  Steosnider,  M.D., 
District  Director  of  Sanitation,  North  Carolina 

Stale  Bmn-d  of  Health. 


The  management  of  the  child  from  infancy  to 
the  age  of  10  year-  is  the  period  of  phenomenal 
development,  and  it  is  during  this  period  that 
the  foundations  are  laid  of  those  factors  which 
make  most  for  success  in  after  life — a  well-de- 
veloped body,  sound  health  and  a  good  digestion. 
In  so  far  as  these  fall  short  of  the  normal,  just  so 
far  does  the  individual  miss  bis  full  effectiveness 
in  the  world's  work. 

The  loss  to  the  State  of  North  Carolina  in  earn- 
ing power  from  preventable  diseases,  such  as  tu- 
berculosis, typhoid  fever  and  hookworm,  i-  enor- 
mous, even  though  we  are  already  in  possession 
of  prophylactic  measures  of  every-day  medicine 
which,  if  conscientiously  applied  to  each  member 
of  the  community,  would  produce  incalculable 
results. 

Few  will  deny  that  the  recent  victory  of  Japan 
over  Russia,  which  was  up  to  this  time  thought  to 
be  the  peer  of  any  nation  as  regards  army  effi- 
ciency, was  due  to  Japan's  sanitation.  Russia 
lacked  that  fundamental  which  so  many  sections 
of  our  State  are  deficient  in  today,  and  thai  is 
the  application  of  the  principles  of  sanitation. 
Japan  taught  the  world  the  most  practical  and 
demonstrative  lesson  ever  enunciated  in  sanita- 
tion. War  records  previous  to  the  Kusv '-Jap- 
anese War  showed  that  equally  as  many,  and  oft- 
times  more,  men  succumbed  to  disease  as  to 
bullets. 

So  long  as  it  is  considered  good  business  policy 
to  study  and  apply  devices  which  make  labor 
more  effective,  there  is  nothing  vague  or  vision- 
ary in  applying  to  the  future  laborer  health-saving 
devices  which  will  make  him  physically  and  men- 
tally fitter  for  his  work. 

Since  the  foundations  of  a  sound  physique  are 
laid  in  infancy  and  childhood,  and  if  neglected 
cannot  be  rebuilt,  we  have  a  problem  worthy  of 
our  most  earnest  consideration.  When  we  con- 
sider the  cost  of  living  out  of  proportion  to  the 
increase  in  wage  we  have  a  condition  which  en- 
hances rather  than  lessens  these  hereditary  and 
congenital  weaknesses  which  cause  many  deaths 
in  earlv  infancy. 


32 


THE    HOSPITAL    BULLETIN 


The  question  of  hygiene  and  sanitation  is  an 
educational  one  which  will  take  much  time  to 
get  firmly  fixed  in  the  minds  of  our  good  people. 

We  must  make  it  plain  to  our  people  that  no 
man  has  a  right  so  to  keep  his  house  or  so  to  live 
his  life  in  a  civilized  community  as  to  jeopardize 
his  neighbor's  health  or  happiness.  Again,  the 
duty  of  keeping  clean  in  a  physical  sense  is  as  high 
as  that  of  moral  cleanliness. 

Is  it  not  infinitely  wiser  to  prevent  the  pollu- 
tion  of  our  drinking  water  or  food  than  to  fight 
the  result  of  that  pollution,  as  is  the  case  with 
typhoid  fever  gotten  by  drinking  dirty  surface 
water  or  eating  food  polluted  by  flies  which  have 
cnme  in  contact  with  a  typhoid  fever  case? 

Again,  is  it  not  wiser  to  prevent  soil  pollution 
by  using  sanitary  privies  and  thereby  eradicate 
hookworm  disease,  which  at  present  exists  in  the 
C  entral  and  Eastern  part  of  our  State  to  the  ex- 
tent of  from  36  to  58  per  cent.,  than  to  allow  this 
easily-preventable  disease  to  go  on  sapping  the 
life-blood  out  of  our  beloved  children,  dwarfing 
them  mentally  and  physically  for  life,  and  in  nu- 
merous cases,  directly  and  indirectly,  by  other 
diseases,  causing  death? 

Shall  we  not  vaccinate  all  our  people  at  a  cost 
of  2$  cents  each,  rather  than  leave  some  hundreds 
to  die  annually  and  other  thousands  to  be  branded 
with  scars,  a  living  shame  to  the  community? 

\\  ould  it  not  be  wise  to  prevent  stagnant  water 
around  our  homes  and  thus  not  have  a  mosquito 
hatching  place  and  screen  our  home  at  a  small 
ci  1st  against  the  mosquito,  which  causes  malaria 
or  bilious  fever,  than  to  allow  this  pest  to  enter 
our  homes  and  cause  long  illness  and  ofttimes 
death  ? 

Then  we  must  start  with  the  little  ones,  and 
after  seeing  that  their  mothers  are  instructed  in 
the  hygiene  and  clothing,  remove  the  notion  that 
the  children  must  of  necessity  have  measles, 
whooping-cough  and  hookworm  disease  by  show- 
ing them  that  these  diseases  are  ideal  foundations 
on  which  to  build  future  woe  in  the  shape  of  con- 
sumption. 

The  best  way  to  fight  consumption  or  any  other 
disease  is  with  a  sound  body,  the  boy  who  would 
grow  up  to  lie  a  man  of  affairs  must  have  sound 
lungs,  stomach,  eyes,  ears,  teeth  and  good  muscu- 
lar development. 

Every  school  in  the  State  should  have  a  medi- 
cal supervisor  or  inspector  to  inspect  the  exes, 
mouth,  ears  and  general  condition  of  all  children 


in  attendance,  in  order  that  disorders  may  be  de- 
tected at  a  time  when  they  could  be  cured.  As  an 
example,  cross-eyes,  detected  early,  can  be  cured ; 
ear  trouble,  detected  early,  can  be  cured :  diseased 
tonsils,  removed  early  prevent  rheumatism  and 
poor  health.  Hundreds  of  our  friends  are  today 
going  through  life  cross-eyed,  or  blind,  near  or 
far  sighted,  or  deaf,  or  dwarfed  mentally  or 
physically  from  hookworm  disease,  as  a  result  of 
not  receiving  attention  at  the  proper  time. 

For  the  advancement  of  so  important  an  issue, 
let  us  place  the  far-reaching  and  lasting  good  of 
this  work  before  our  lawmakers  and  insist  that 
they  at  least  appropriate  as  much  for  the  pro- 
tection of  their  wives  and  little  ones  as  for  that 
of  their  swine,  cattle  and  poultry. 

Shall  we  make  preventive  medicine  a  very  real 
power  in  our  State?  Or  shall  we  be  content  to 
consider  it  a  side  issue? 

Goldsboro,  N.  C. 


Prof.  Randolph  Winslow  has  received  the  fol- 
lowing  note  in  reference  to  his  recent  series  of 
articles  upon  his  trip  to  the  Pacific  Coast : 

'"Tis  wonderful  why  one,  when  writing  about 
fish,  can't  maintain  the  same  conservative,  mod- 
erate statements  they  do  when  expressing  them- 
selves about  mountains,  canyons,  geysers,  rivers, 
lakes  and  other  marvelous  footprints  of  the  Crea- 
tor. Who  the  devil  ever  heard  of  a  fish  being 
caught  and  cooked  under  such  circumstances  ? 
In  spite  of  the  fish  yarn,  you  have  written  us  a 
series  of  most  interesting  and  instructive  papers. 
\\  hen  your  surgical  day  is  passed,  you  can  turn 
your  attention  to  travel  and  recording  what 
you  see. 

'"Yours  truly, 
"D.  W.  Bulluck  (class  of  1873  ). 

"Wilmington,  X.  C." 

For  the  fish  story  see  January  Bulletin,  page 
203,  illustration  on  page  204. 


Dr.  William  Clinton  Marett.  class  of  1911,  has 
resigned  as  a  member  of  the  medical  staff  of  the 
tuberculosis  hospital  at  Bayview,  and  has  accepted 
a  position  as  assistant  resident  physician  at 
\\  hitehaven  Sanatorium,  Pa.  He  will  enter  upon 
his  new  duties  Tune  1. 


Dr.  Harry  Benjamin  Messmore,  class  of  1910, 
is  located  in  Brownsville,  Pa. 


THE    HOSPITAL    BULLETIN 


33 


THE  HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

PUBLISHED    BY 

THE   HOSPITAL   BULLETIN    COMPANY 

608  Professional  Building 

Baltimore.  Md. 


Subscription  price,     .     .     .     $1.00  per  annum  in  advance 

Reprints  furnished  at  cost.     Advertising  rates 
submitted  upon  request 


Nathan    Winslow,  M.D.,  Editor 


Baltimore,  April  15.  [912. 


AN  EXPLANATION  AND  AN  APPEAL. 


For  a  year  we  have  been  publishing  the  names 
of  those  who  have  subscribed  to  the  Pathological 
Endowment  Fund,  until  the  number  has  grown 
so  large  that  it  is  inconvenient  to  publish  the  list 
in  full.  We  shall,  therefore,  cease  to  present  the 
names  of  each  individual  in  each  issue  of  Tine 
Bulletin,  and  shall  only  mention  the  names  of 
new  subscribers  month  by  month.  We  shall, 
however,  publish  the  amount  subscribed  by  the 
individual  classes  of  the  medical  alumni  in  each 
issue,  as  well  as  the  total  amount  pledged,  up  to 
the  first  of  each  month. 

As  will  be  observed,  almost  every  class  that  has 
left  the  portals  of  the  Medical  School  in  the  past 
40  years  has  thought  enough  of  its  Alma  Mater 
to  make  some  contribution  to  this  fund.  A  few 
classes  have  nut  responded  as  yet  to  our  appeal; 
in  some  instances,  doubtless  because  they  have 
n.l  bein  solicited  to  do  so.  If  any  member  of 
these  classes  should  notice  that  his  class  is  not 
represented  in  this  list,  we  hope  he  will  hasten  to 
send  us  a  contribution,  in  order  that  his  class  may 
have  some  part  in  this  work.  If  anyone  notices 
that  his  class  has  only  a  small  sum  credited  to  it. 
we  hope  he  may  add  something  to  the  class  fund. 
If  anyone  thinks  he  can  increase  his  contribution 
comfortably,  his  generosity  will  be  greatly  appre- 
ciated. 

The  past  month  has  been  rather  barren  of  re- 
sults. There  has  been  so  much  to  occupy  our  at- 
tention that  not  much  effort  has  been  bestowed  on 
this  enterprise.     We  hope,  however,  that  the  ad- 


vent of  spring  will  lighten  our  labors,  and  that 
coin,  to  say  nothing  of  green  and  \  ellou -backed 
bills,  may  flow  so  abundantly  into  the  coffers  of 
our  friends  that  they  will  have  enough  to  spare 
us  some  of  the  overflow. 
Friends,  help  us! 


CONTRIBUTIONS  BY  CLASSICS. 


848  . 

SOS. 

871. 
872. 
873. 


*74 

8/5 

876 

*77 

880 

8S1 

882 

883 

885 

886 

sss 

889 

890 

892 

003 

894 

895 

896 

897 

898 

900 

901 

902 

903 

904 

905 

906 

007 

909 

910 

911  Terra  Mariae 

012  Latin-American  Club. 


$50 

00 

10 

00 

35 

00 

''5 

00 

430 

00 

5 

00 

5 

00 

i'5 

00 

10 

oo 

5 

00 

250 

00 

310 

00 

35 

00 

235 

00 

100 

oo 

50 

00 

100 

00 

175 

00 

150 

00 

15 

00 

'35 

00 

'55 

00 

52 

00 

70 

00 

80 

00 

215 

00 

'75 

00 

305 

00 

300 

00 

145 

00 

200 

00 

130 

00 

no 

00 

5 

00 

50 

00 

3  5o 

25 

00 

Total  subscriptions  to  April  I,  1912.    $0805   50 

Subscriptions  in  March: 
Dr.    Nathan    Winslow.    IQOI     (second 

contribution  ) §5°  03 

Dr.   Randolph  Winslow.  1873   1  second 

contribution) 100  00 


34 


THE    HOSPITAL    BULLETIN 


Dr.  Erasmus   II.    Kloman,    19x0    (sec- 
ond  contribution  ) 25  OO 


Additions  for  the  month $175  00 


ITEMS 
By  request,  we  publish  the  following  list  of  the 
class  of  UJ05,  with  their  present  locations,  so  far 
as  we  are  able  to  ascertain : 

Elmer  Hall  Adkins. 

Julian  Warrington  Ashbv,  Hugheston,  W.  Ya. 

Samuel  Luther  Bare,  Westminster,  AIL 

Robert  Parke  Bay,  1701  Guilford  avenue,  Bal- 
timore, Aid. 

Chandos  M.  Benner,  Taneytown,  Md. 

lames  Snow  Billingslea,  Armiger,  Aid. 

Alvah  Parrish  Bohannon ;  can't  locate:  in  the 
State  of  Virginia;  not  in  practice. 

Vance  VV.  <  Irabham,  Bamberg,  S.  C. 

Baird  U.  Brooks,  West  Durham,  N.  C. 

Frank  Burden,  Paw  Paw,  W.  Va. 

Ira  Burns,  Relief  Department,  Pennsylvania 
Railroad  Co.,  Wilmington,  Del. 

Roscoe  C.  Carnall,  Waverly  Alills,  S.  C. 

John  Joseph  Carroll,  120  Chestnut  street, 
Holyoke,  Mass. 

Edward  Lawrence  Casey,  Woodstock,  N.  H. 

Sydenham  Rush  Clarke,  423  Hawthorne  road, 
Roland  Park,  Aid. 

Edward  V.  Copeland,  Round  Hill,  Va. 

Arthur  Bascom  Croom,  Alaxton,  X.  C. 

Charles  Callery  Croushore,  108' West  2d  street, 
Greensburg,  Pa. 

Frederick  De  Sales  Chappelier,  Lewes,  Del. 

Seth  De  Blois,  Newport,  R.  I. 

David  Alphonse  DeVanny,  132  East  61st  street. 
New  York,  N.  Y. 

Alpheus  Wood  Disosway,  Plymouth,  N.  II. 

Manuel  Dueno,  Anasco,  Alayaguez,  Porto  Rico. 

James  Eugene  Dwyer. 

John  Alartin  Elderdice,  Alardela  Springs,  Md. 

Oliver  Justin  Ellis,  South  Royalton,  Vt. 

Harry  Aloore  Felton,  109  Climax  street,  Pitts- 
burgh, Pa. 

Edwin  Ferebee  Fenner,  Henderson,  W.  Va. 

William  Henry  Fisher,  Centreville,  Aid. 

John  Shaw  Gibson,  Gibson,  X.  C. 

Milton  R.  Gibson,  Alaxton,  X.  C. 

Leo  J.  Goldbach,  2217  East  Pratt  street.  Balti- 
more, Aid. 

Archibald   Wright  <  iraham. 


William  W.  Hala,  Xew  York,  X.  Y. 

Samuel  William  Hammond,  Lambert's  Point, 
Norfolk,  Va. 

George  Blight  Harrison. 

Henry  Hiram  Hodgin,  Red  Springs,  X.  C. 

Henry  C.  Houck,  1914  Pennsylvania  avenue, 
Baltimore,  Md. 

Hammer  Carson  Irvin,  Jr.,  Roanoke  Rapids, 
X.  C. 

Brooke  I.«  Jamison,  Jr.,  Emmitsburg.  Aid. 

Francis  White  Janney.  The  Walbert,  Balti- 
more, Md, 

Harry  Aquilla  Jenkins,  Assistant  Surgeon,  U. 
S.  X.,  now  on  board  U.  S.  S.  Alontana. 

Oswald  Ottmar  Kafer,  Xewbern,  X.  C. 

Xagib  Kenawy,  11  Boulevard  de  Ramleh, 
Alexandria,  Egypt. 

Eugene  Kerr,  Alonkton,  Aid. 

Herbert  L.  Kneisley,  Hagerstown,  Aid. 

William  A.  Knell,  Augusta  avenue  ami  Fred- 
erick road,  Irvington. 

Kalil  Alagib  Koury. 

Edgar  Brown  Le  Fevre,  Inwood,  W.  Va. 

Julius  Levin;  died  in  Johnstown,  Pa.,  February 
12,  [912. 

George  William  Alahle;  died  in  Baltimore,  Aid.. 
February  20,  191 1. 

James  P.  Alatheson,  Charlotte,  X.  C. 

James  G.  Alatthews,  Paulsen  Building.  Spo- 
kane, Wash. 

George  Skinner  AlcCartv. 

Harry  Downman  AlcCartv,  613  Park  avenue. 

John  1'.  McGuire,  Clarksburg,  W.  Va. 

William  Cuthbert  AIcGuire,  Huntington,  W. 
Ya. 

Roscoe  Conkling  Metzel,  1824  West  Xorth 
avenue,  Baltimore,  Aid. 

Harold  Edson  AIinei-,51  Alaple  street,  Holyoke, 
Mass. 

Robert  Levis  Mitchell,  21 12  Alaryland  avenue, 
Baltimore,  Aid. 

William  Morris  Alitchell,  80  Kennedy  street. 
Bradford,  Pa. 

John  Albert  Nice,  Alt.  Airy,  Aid. 

Oscar  S.  Owens,  Alanchester,  Ya. 

John  W.  Parker,  Jr.,  Williamston,  S.  C. 

W.  Arlett  Parvis,  Acting  Assistant  Surgeon, 
U.  S.  A. ;  at  present  at  Sorocco,  X.  AI. 

John  William  Pierson,  2806  East  Baltimore 
street.  Baltimore,  Aid. 

Daniel  E.  Remshurg,  Cresson,  Pa. 

Samuel  T.  R.  Revell,  Louisville,  Ga. 


THE    HOSPITAL    BULLETIN 


35 


William  James  Riddick,  Assistant  Surgeon, 
I".  S.  N. ;  at  present  at  Naval  Station,  Guanta- 
namo,  Cuba. 

William  Wordsworth  Riha,  Danvers  Hospital 
for  Insane,  Danvers,  Mass.  i  ?). 

John  L.  Riley.  Pocomoke  City,  Md. 

John  Edgar  Rooks. 

Anton  George  Rytina,  2204  East  Monument 
street,  Baltimore,  Md. 

Edgar  McQueen  Salley,  Saluda,  N.  C. 

Albert  Leigh  Sanders,  1113  North  Gilmor 
street,  Baltimore,  Md. 

Sturat  Baskin  Sherard,  Gaffney,  S.  C. 

John  Holmes  Smith.  Jr.,  2205  St.  Paul  street. 
Baltimore,  Aid. 

W.  Henry  Smithson,  Jr..  New  Park,  Pa. 

James  Albert  Stone,  Shallotte,  N.  C. 

Benjamin  Franklin  Tefft,  Jr.,  Anthony.  R.  I. 

William  E.  Ellicott  Tyson,  2609  Past  Jefferson 
street,  1  )etroit,  Mich. 

Frederick  J.  Wass,  136  East  Duvall  street. 
Jacksonville,  Fla. 

William  Benjamin  Warthen,  Davisboro,  Ga. 

We  would  he  very  glad  if  some  of  our  readers 
can  supply  the  missing  addresses. 

Dr.  James  G.  Matthews,  class  of  1905,  of 
Spokane,  Wash.,  was  a  recent  visitor  in  Balti- 
m<  ire. 


Miss  George  Allen  Hutton,  class  of  191  r.  Uni- 
versity Hospital  Training  School  for  Nurses,  is 
recovering    from    pneumonia    at    the    University 

1  lospital. 


Dr.  Francis  Miles  Chisolm,  class  of  1889,  has 
given  up  his  offices  in  the  Farragut,  Washington, 
D.  C,  and  will  devote  his  entire  time  to  his  home 
office,  1032  Rhode  Island  avenue  N.  W.,  Wash- 
ington. 


Dr.  George  W.  Dobbin,  class  of  1894,  was  op- 
erated on  for  appendicitis  at  the  Mercy  Hospital 
March  15,  191 2.    He  is  reported  to  be  doing  well. 


Dr.  Bennett  Bernard  Browne,  class  of  1807, 
has  been  confined  to  his  home.  510  Park  avenue. 
Baltimore,  with  a  slight  attack  of  blood  poison- 
ing, caused  by  a  slight  abrasion  of  the  skin,  incur- 
red while  operating. 


Dr.  John  C.  Hemmeter,  class  of  [884,  gave  a 
lecture  on  the  "Physiologic  Foundations  of  Piano 
Technic"  before  the  Florestan  Club,  522  X. 
Charles  street,  Baltimore,  on  March   11,1.  1012. 


We  would  be  very  glad  if  any  of  our  readers 
can  give  us  the  present  address  of  Dr.  Vernon 
Hastings  McKnight,  class  of  IQIO. 


Dr.  Robert  Alexander  Warren,  class  of    [907, 
is  located  at  Midway  Inn,  Hot  Springs,  Va. 


The  following  charter  has  been  granted  the 
Alumni  Athletic  Association  : 

THIS  IS  T(  )  CERT!  FY  that  the  subscribers- 
Irving  J.  Spear,  residing  in  Baltimore  City; 
Nathan  Winslow,  residing  in  Baltimore  City: 
Daniel    Base,   residing   in    Baltimore   Citv; 
Fred  H.  Vinup,  residing  in  Baltimore  Citv,  ami 
James  W.  Bowers,  residing  in  Baltimore  City, 
all  of  whom  are  citizens  of  the  State  of  Marvland, 
all  being  of  full  legal  age,  do  hereby  certify  that 
we  do,  under  and  by  virtue  of  the  General  Law 
of  this  State  authorizing  the  formation  of  corpo- 
rations, associate  ourselves  with  the  purpose  of 
forming  a  corporation. 

1.  The  name  of  the  association  is  the  "Alumni 
Athletic  Association  of  the  University  of  Mary- 
land,  Incorporated." 

2.  We  do  further  certify.  That  the  purpose 
fi  ir  which  said  corporation  is  formed  and  the  busi- 
ness or  objects  to  be  carried  on  and  promoted  by 
it  are  the  promotion  and  advancement  of  athletics 
at  the  LTniversity  of  Maryland,  the  creation  and 
maintenance  of  high  standards  of  sportsmanship 
among  the  students  of  the  LTniversity  of  Mary- 
land, and  for  social  and  literary  purposes,  and  that 
the  said  corporation  is  formed  upon  the  articles, 
conditions  and  provisions  herein  expressed,  and 
subject  in  all  particulars  to  the  limitations  relat- 
ing to  corporations  which  are  contained  in  the 
General  Laws  of  this  State. 

3.  We  do  further  certify,  That  the  principal 
office  of  said  corporation  will  lie  located  in  Balti- 
more City. 

4.  H'c  do  further  certify.  That  the  said  corpo- 
ration is  to  have  no  capital  stock. 

5.  We  do  further  certify,  That  the  said  corpo- 
ration will  be  managed  by  eight  Directors,  and 
that  Irving  J.  Spear,  Nathan  Winslow.  James  W. 
Bowers,  John  Henry  Skeen,  B.  Merrill  Hopkin- 
son,  Samuel  W.  Moore,  Daniel  Base  and  John  B. 


36 


THE    HOSPITAL    BULLETIN 


[seal. "I 
[seal.] 

I  SEAL.] 

[seal.] 

[seal.] 


Thomas — all  of  whom  are  citizens  of  the  State 
of  Maryland  and  actually  reside  therein— are  the 
names  of  those  who  shall  act  as  Directors  of  the 
said  corporation  for  the  first  year,  or  until  their 
successors  are  duly  chosen  and  qualified. 

In  witness  whereof ,  We  have  hereunto  set  our 
hands  this  first  day  of  December,  in  the  year 
nineteen  hundred  and  eleven. 

Witness: 
Ws.  to  all. 

John  Henry  Skeex.   (Signed.) 
Irving  J.  Spear. 
Nathan  Winslow. 
James  W.  Bowers. 
Fred  H.  Vinup. 
Daniel  Base. 
State  of  Maryland.  City  of  Baltimore,  to  wit.: 
Before  the  subscriber,  a  Notary  Public  of  the 
State  of  Maryland,  in  and  for  the  City  of  Balti- 
more, personally   appeared  on   this   first  day  of 
December,  nineteen  hundred  and  eleven.  Irving 
J.  Spear,  Nathan  Winslow,  Daniel  Base,  Fred  H. 
Yinup  and  James  \Y.  Bowers,  and  did  severally 
acknowledge  the  foregoing  certificate  to  be  their 
act. 

Witness  my  hand  and  notorial  seal, 

Johx  Henry  Skeex, 

Notary  Public. 
I,  one  of  the  Judges  of  the  Supreme  Bench  of 
Baltimore  City,  do  hereby  certify  that  the  fore- 
going certificate  has  been  submitted  to  me  for 
examination :  and  I  do  further  certify  that  the 
said  certificate  is  executed  in  conformity  with 
the  law. 

Carroll  T.  Boxn. 


ATHLETICS. 
The  basketball  season  has  closed  with  a  credit- 
able record  of  clean  playing"  and  good  sportsman- 
ship on  the  part  of  the  University  team. 


The  Pennsylvania  Chapter  of  the  General 
Alumni  Association  of  the  University  of  Mary- 
land has  elected  the  following  officers  for  the 
coming  year: 

President,  Dr.  Lewis  H.  Adler,  class  of  1859, 
of  Philadelphia;  vice-president,  Dr.  J.  Bruce 
McCreary,  class  of  1892,  of  Shippensburg  ;  sec- 
retary. Dr.  J.  C.  C.  Beale  of  Philadelphia :  execu- 
tive committee,  Drs.  Frank  IT.  Gaverik.  class  of 
1888,  and  Harry  C.  Stover,  both  of  Harrisburg; 
William  J.  Steward,  class  of  [904,  and  W.  H. 
Lowell,  both  of  Lancaster;  James  C.  Clawson, 
class  of  1855.  and  Robert  C.  White,  both  of 
Philadelphia :  Edwards  F.  Winslow  of  Bryn 
Mawr;  Z.  C.  Meyers,  class  of  1890,  and  R.  S. 
Xeiman,  both  of   York.   I'a. 


The  lacrosse  team  has  cancelled  the  remaining 
games  of  its  schedule  because  of  lack  of  practice. 
The  game  played  with  the  Navy  team  on  March 
28  resulted  in  an  easy  victory  for  the  middies, 
and  was  the  only  game  played  by  the  University 
twelve  during  the  season. 

The  baseball  team  is  making  a  strong  bid  for 
the  intercollegiate  championship  of  the  State. 
Five  games  have  been  played,  of  which  number 
the  University  boys  have  won  three.  The  team 
is  putting  its  best  play  against  the  colleges,  and 
has  been  handicapped  by  an  accident  to  Wood- 
land, who  sprained  his  ankle  at  the  Westminster 
game.     The  record  of  the  games  is  as  follows : 

The  initial  game  of  the  season  was  played 
March  20  against  the  Navy  at  Annapolis.  A 
great  deal  of  local  interest  centered  in  the  game 
because  of  the  fact  that  Harry  Ruhl  and  Harry 
Butler,  both  former  St.  John's  College  boys, 
played  on  the  University  team.  The  score  was 
5  to  3.  in  favor  of  the  Navy. 

The  Baltimoreans  started  the  scoring  in  the 
opening  session,  when  they  chalked  up  a  run  on 
Sherrill's  hit,  a  pass  to  Whitworth,  followed  by 
O'Neill's  single.  Navy  went  one  better  in  the 
third,  on  a  fielder's  choice,  and  Vaiden's  long- 
drive  to  left,  which  was  good  for  three  sacks,  but 
he  stretched  it  into  a  homer  on  Beach's  poor 
handling  of  the  throw-in. 

In  the  fourth  the  visitors  added  two  more,  and 
Navy  evened  things  up  with  a  tally  in  the  same 
session.  In  the  sixth  the  middies  clinched  the 
game,  when  they  registered  two  more,  on  a  base 
on  balls,  an  error  and  wild  pitch  by  Woodland. 
.  Vinson,  Navy's  star  twirler  of  last  season,  was 
on  the  mound  for  four  innings.  Seibert,  a  south- 
paw, who  replaced  him,  was  more  effective. 

NAVY.  MARYLAND. 

AB.R.II.O.A.E.  AB.R.H.O.A.E. 

Osborne,   If....  4    1    0   "  0  11  Butler,  3b 5    110  0  1 

Valden,   3b 4    12   0  2  0  Sherrill,   c 5    1    2    S  1  0 

Fisher,  rf 4   0    1    1  0  0  Whitworth,   If.  4022  11  0 

Abbott.   21. 4    0    0    0  2  1  O'Neill,    ss 4    0    2    3  2  0 

Hall.   II. 4    0    2  13  "  1  Smith,    lb 4    0    19  0  0 

Adams,   ss 411030  Jenkins,   rf....  400000 

livers,    ci :•■    0    10    10  Ruhl.  2b 4    0    0    15    2 

Hicks,    <• 3    1    0  12    2    0  Beach,    of 2    10    10    1 

Vinson,   p 1   0   0   0  1   0  Woodland,  p...  3   0   0   0   4   0 

Seibert,   p ::    1    1    1    1    0  Woods,  p 1   0   0   0    10 


Totals 34    5    8  27  12    2  Totals 3G    3    8  24  13    4 

Navj 00210200   x— 7, 

Maryland 10020000   0—3 

Two-base  hit — Vaiden.  Three-base  hit — Vaiden.  Left  on 
iias--s  -Navy,  7  :  Maryland,  8.  First  base  on  errors—Navy,  3  ; 
Maryland,  2.     Innings  pitched— By  Vinson,  4;  by  Seibert,  5; 


THE    HOSPITAL    BULLETIN 


37 


by  Woodland,  6V4;  by  Woods,  3%.    Struck  out— By  Vinson,  5; 

by  Selbert    7:  bv  W Hand,  3;  by  Woods,  3,    Bases  on  balls— 

<iiT  Vinson    2;  off  Selbert,  I:  off  Woodland,  3,    I  his -oil   Vin- 
son   5:  "IV  Selbert.  2;  off  Woodland,  7:  off  Woods,  1.     w  iid 

pitch— W Hand.    Dmpire— Mr.  McA1 f  Baltimore.    Time— 

2.10. 


Howard.  S.     Batters  hit— Bealle   (2).     Struck  out-  By  Woods, 
i'.  ;  by  Howard,  5.    Time— 2.10.    Umpire— Dooley,  W.  M.  C. 


The  next  game,  played  .March  iy  against 
Washington  College  at  Chestertown,  resulted  in 
a  victory  For  the  .Maryland  boys — 3  to  o. 

The  University  team  showed  great  improve- 
ment over  the  playing  during  the  Navy  game, 
1  bach  W'illse  having  detected  the  errors  made  in 
the  former  game  and  put  the  knowledge  to  good 
use  in  the  practice  held. 

The  work  of  Woods  for  the  Varsity  was  of  a 
high  order,  as  he  allowed  hut  three  hits  and 
walked  one  man.  Biddle,  for  Washington  Col- 
lege, was  touched  up  for  seven  hits  and  gave  sev- 
eral hases  on  balls. 

The  University  started  its  scoring  in  the  first 
inning. 

1  larry  Ruhl  played  a  star  game  for  the  Univer- 
sity at  the  first  base.  This  was  Ruhl's  first  try- 
out  in  this  position,  and  he  made  good. 

WASHINGTON.  UNIVERSITY    OF   MD. 

AB.R.  H.  O.  A.E.  AB.R.  H.  O.  A.E. 

Meckins.  3b....  4    0    o    0   4    1       Butler.  :VI> 3    0    2    2    11    0 

Brown     If 4    0    2    2    0    0       Beach,   of 4    0    1    2    0    0 

Kelly    2b 4    0    (I    3    2    0  WMtworth,    c.  4    1    1    1    2    0 

Porter.    11. 4    0   0  12    11    0  Jenkins,   2b....  4   0    0    13    0 

Karrett    cf 3   00200      O'Neill,  ss 4   00220 

Lewis,   ss 3    0    0    2    0    1       Smith,    rf 4    110    0    0 

Long     c 3    0    13    2    0       Ruhl.  lb 4    1    113    11    11 

Wallace,    rf....  3    0   0   0    10       Blnlock.   If 4   0   10   10 

Biddle.  p 3    0   0    15    0       Woods,    p 4    0   0    0    5    0 

Totals 31    0    3  25  14    2  Totals 35    3    7  2113    0 

Score  by  innings  : 

University  of  Maryland 10   0   0   0  0   10   1-3 

Washington 0    0   0    0   0   0   0   0   0-0 

Two-base   hits— Butler,   Blalock,   Brown.     Three-base   hits— 

1 g,    smith.     Sacrifice    hits— Washington,    2:    University   of 

Maryland.  1.  Stolen  bases— University  of  Maryland.  2:  Wash- 
ington. 1.  Double  plav— Biddle  lo  Porter.  Bases  on  balls- 
Off    Biddle,   3;    off    Woods,    1.  Batters   hit— By    Biddle,   3:   by 

W Is.    1.     Strnek   out— By    Biddle.   3;    by    Woods.   5.     Passed 

ball— bv  Woods  to  catcher.  Left  on  bases— Washington,  4: 
University  of  Maryland,  7.  Time  of  game— 1.55.  Umpire — 
Pensmith. 


The  third  game  was  played  against  Western 
Maryland  College  March  30.  Our  boys  won — 
8  to  4.  Woodland  did  splendid  work,  but  was 
hurt  in  the  fifth  inning  and  has  been  unable  to 
play  since.     The  score  was : 

UNIVERSITY    OF    JIli.  WESTERN   MARYLAND. 

AB.R.  II.  O.  A.E.  AB.R.  H.  O.  A .  E. 

Holler.    3b 6    10    13    1        Jones,    of 4    10    2    0    0 

Beech    if 422200  Spragne,  lb....  4   0   011    1   1 

Wbltworth,    c.  6    2    2  10    2    0       Bealle.  c 4    2    3    9    3    0 

Smith     rf 3    0    o    1    0    0        Graefe.    if 3    0    II    1    0    0 

Nitsche,    rf....  2    0    »    0    «    0       Myer,   If 211100 

Cooper,  of 221100       Foltz,  ss 3    0    0   0    3    1 

Jenkins    2b....  r,    1    2    2    2    1  FriesleV,  8b....  3    0    0    14    0 

oNeill.    ss 4     0    0    0    2     1         Hill.    2b 3    0    0    2    0    1 

Ruhl    lb 4    0   0111    1    0       Howard,  p 3    0    1    0   0   0 

Woodland,  p...  2   ooooo  

Woods,    p 2    0    1     0    1     0  Totals 29     4     5  27  11     3 

Totals 40    8    S  27  11    3 

University  of   Maryland o   n   l   o   3   o   l    i    2—8 

Western    Maryland 2    0   0    o    l    o    0    0    1—4 

Two-base  bits— Bealle.  Jenkins.  Three-base  bits— Bealle  (2). 
Stolen  bases— Butler.  Wliitworth  (2),  Jenkins.  Cooper  (2). 
Bealle       Bases    (,n    balls— Off    Woods,    1;    off    Woodlawn.    3;    Off 


The  fourth  game,  slated  against  Mt.  St.  Mary's 
College  April  2  at  Emmitsburg,  Md.(  was  called 
off  because  of  rain. 


The  fifth  game  was  played  against  Dickinson 
College  at  Carlisle  April  6,  anil  gave  the  Mary- 
land team  a  victory  of  3  to  2.  The  weather  was 
ideal  and  the  game  well  attended.  The  Mary- 
land boys  showed  their  superiority  over  the  Car- 
lisle boys  both  in  fielding  and  in  batting.  The 
score  was  as  follows : 

UNIV.    OF   MD.  DICKINSON. 

R.  II.  o. A.E.  R.H.O.A.B. 

Butler,    ss 2    0    11    0  Stechel,    ss 0  13    12 

Jenkins.    2b 0    2    5    11  Goldstein,     c 0  2    2    10 

Whitworth,    O....0    2  10    1    0  Hoeh.     of 2  1  11    1    0 

Smith,    of 0    3    0    0    1  Henderson,    lb...O  0    13    2 

Nitsehe.    If 1    2    0    0    0  Grimm,     2b„ 0  1110 

Ruhl.    lb 1    0  10    0    0  Rowley,    rf 0  0    0    10 

O'Neill,     ss 1    2    0    4    0  Price,    3b 0  14    0    0 

Morton,    rf 0    0    (I    0    0  Patterson.    If 0  0    0    0    0 

Wood,    p 0    0    14    0  Shaffer.    If 0  0    3    0    0 

Brenneman,     p...  0  0    1    0    1 

Totals    5  1127  11    2  York,    p 0  0    14    0 


Totals    2    6  27  12    5 

University   of  Maryland 1    n    0    n    1    2    1    0    0—5 

Dickinson    0    o    o    o   0    0    1   0    1—2 

Two-base  hit— Smith.     Home  run— Hocn.  Bases  on  balls— Off 
York,  1 ;  off  Wood,  9.     SI  ruck  out— By  York,  3. 


The  sixth  game  was  played  against  the  Balti- 
more (International  League)  team,  and  was  won 
by  the  Orioles  by  a  score  of  16  to  6.  The  Univer- 
sity team  kept  in  reserve  its  best  players  for  later 
college  games  and  put  its  weakest  team  against 
the  Orioles,  trying  out  a  new  pitcher  in  one 
inning.  Nine  runs  were  scored  in  this  one 
inning.  Much  interest  was  added  to  the  game 
in  the  fact  that  Unglaub,  a  University  of  Mary- 
land man  in  the  days  of  Micky  Whitehurst,  was 
playing  on  the  Oriole  team,  and  made  one  run 
against  the  boys  of  his  Alma  Mater.  After  the 
fourth  inning  Manager  Dunn  of  the  Orioles 
changed  his  line-up,  bringing  in  his  reserves.  The 
Sun  writes:  "In  the  field  the  losers  played  cleaner 
ball  than  the  Orioles,  but  several  errors  of  omis- 
sion were  costly."  Several. hundred  students  sat 
in  the  grandstand  and  cheered  the  University- 
boys.     The  score  was  : 

BALTIMORE. 
Play.  i.  AB.  R.  1B.TB.SH.SB.SO.BB.PO.  A.  E. 

F.  Maisel.    ss 3      2      2      2      0      10      1112 

Twombly,    ss 2     o     o     0     0     0     0     0     0     1     1 

I'orcoran.     rf 4      2     4     6     0     0      0      0      0     0      0 

Cooper,     rf 2     0000010000 

Gettman,    ef 2     3     12     0     10     2     0     0     0 

Murray,    cf 2      0      1      2      0      0      0      0      10      1 

Schmidt,    lb 3      1130101900 

G.  Maisel.    lb 2      0      0     i 0     0     5      o      o 

Walsh.     If 6      125      0      2      00000 

1 'a  rent.     2b 1212      0      102021 

Unglaub,   2b 3     1110000021 

Murphy      3b 3      2      2      3      0      0      o      2      0       4      0 

Payne,    c 3     12300011101 

Russell,      p 5        10        0        0        13        0       0        10 

Totals    41    10    17    29      0      7      4      9    27    11      7 


38  THE    HOSPITAL   BULLETIN 

onv^ ^b^shI^o.bb.po .a.  e.  Dl""  Wllliai»  T"  Arnold>  ^  of  l875-  died  at 

Butler   3b i    2    2    2    o    o    l    1441  his  home,  8233/  \Y.  Lombard  street,  Baltimore, 

Until,     lh -111-101      1      0      1 

Whitwortb,  c- 5    0    11    0    0    0    o    0510  March  ?.  iQi-2,  after  a  lingering-  illness,  ased  67 

Smith,    cf 5     2     -j     5     11     1     1     0  °  -     J                            &        6              ->  "S"1     ' 

Nitsche,    if 5    1000210301  years. 

Jenkins,    2b 3     0     2     2     0     2     0     2     4     4     1 

3K   S:::::::::::::::"i    .1    o    o    o    ,1    ii    o    !.'    o    o  Dr.  Arnold  was  born  in  Baltimore,  the  oldest 

^J"-  rpf •  p J    g    J    \    !!    II    J    \    \    \    \  son  of  the  late  Francis  and  Sarah  Mitchell  Arnold. 

Sen'    lE^lE^.i    0    o    o    0    0    l    o    o    3    o  He  was  educated  at  the  old  Lester  Academy  of 

•Rowe    J  _o  _o  _o  _o  _o    l  _o.  _o  _o  _o  West   Baltimore,   and   then   entered  the   medical 

'i'»tals  •■. .•■■■;*    !;  ,,;'  r-    -    6  10    5  M  1G    5  department  of  the  University.     After  graduating 

*ltatted  for  <  ooper  in  the  ninth.  r                                                         J                     o                    o 

Two-base  hits-Parent  (2),  Corcoran  (2),  Gettman,  Payne,  there,  he  took  a  course  at  the  Baltimore  College 

\Y:ilsh.    Murphy,    .Murray.    Smith.     Three-base    hits— Schmidt,  r   rwit.,1    ^..r.-ror,- 

Walsh.   Smith.     First   has.'  on   errors— Baltimore,  4:   Univer-  ul  uciiidi  ouigti_\. 

sity  of  Maryland,  4.    Left  on  bases— Baltimore,  11 ;  rjniversity  . 

of  Maryland,  12.    Tinu— 2.15.    Umpire— Mullaney.  Dr.   Arnold  never  married.      He  gave  up  the 

To  date  the  consensus  of  opinion  of  the  sport-  practice  of  medicine  because  of  ill-health  about 

ings  news  editors  is  that  the  Maryland  team  may  20  years  before   his  death.     He  is   survived   by 

well  be  proud  of  Butler,  Ruhl  and  Woods.  three  sisters  and  three  brothers.     Interment  was 

. .  in  Loudon  Park  Cemetery.  Baltimore. 

BIRTHS  

March  9,  191 2,  Mary  Eleanor  Tucker,  daughter 

of  Dr.  Henry  McKee  Tucker,  class  of  1899,  and  ])r   John  Guy  Hollyday,  class  of  1868,  died  at 

Mrs.  Tucker,  of  Raleigh,  X.  C.  his  officej  7U  Frederick  avenue.  Baltimore,  March 

15,  1912,  of  pneumonia,  in  his  67th  vear. 

In    February.    Virginia    Katheryn    Messmore,  Dr    Hollyday  was  born  in  Hagerstown,  Md., 

.laughter  of  Dr.  John   Lindsey   .Messmore,  class  May  I0<  lS^  the  son  of  Richard  T   all(,  Susat] 

of  1909,  and  Mrs.  Messmore,  of  Masontown,  Pa.  (Ragan)    Hollyday,    and    grandson    of    Colonel 

Pagan  of  Hagerstown,  a  hero  of  the  War  of  181 2. 

DEATHS  Richard    Tilghman    Hollyday,    Dr.    Hollyday's 

Dr.  John  Evans  Mackall,  class  of  190S,  died  at  father,  was  a  farmer  and  slave-owner,  and  was 
his  home  on  Bright  street,  Elkton,  Md..  April  4,  born  at  the  old  Hollyday  estate  in  Queen  Anne's 
1012,  after  a  three  weeks'  illness  of  typhoid  fever,  county,  Readbourne,  which  only  a  few  years  since 
aged  29  years.  Dr.  Mackall  was  the  son  of  Mr.  passed  out  of  the  hands  of  the  1  follyday  family, 
and  Mrs.  William  H.  Mackall  of  Elkton.  He  Dr.  Hollyday  was  educated  in  private  schools 
was  educated  in  the  public  schools  of  Elkton  and  and  at  Hagerstown  Academy  until  he  was  16 
Delaware  College.  For  two  years  after  his  grad-  years  of  age,  when  the  Civil  War  began.  Dr. 
nation  he  was  vice-principal  of  the  Elkton  High  Hollyday  and  a  companion  started  to  join  the 
School,  resigning  to  enter  the  University  of  Confederate  Army,  but  after  their  intentions  lie- 
Maryland,  where  he  graduated  in  medicine  in  came  known  were  forced  to  hide  for  several 
1908.  He  then  served  for  some  time  on  the  staff  months  in  an  attic  in  Dr.  Hollyday's  home,  in 
of  physicians  of  the  Atlantic  Coast  Line  Hospital  order  to  escape  capture  by  Union  soldiers.  They 
at  Rocky  Mount,  N.  C.  He  began  practicing  in  then  joined  the  First  Maryland  Cavalry  at  Fred- 
Elkton  about  a  year  ago.  Dr.  Mackall  was  1111-  crick,  and  served  throughout  the  war.  After  it 
married.  was  over  he  came  to  Baltimore  and  studied  medi- 

The  funeral  took  place  from  his  home  on  April  cine  at  the  University,  graduating  in  1868,  and 
8,  Rev.  William  Schouler  of  Trinity  P.  E.  Church  being  a  house  student  during  that  year.  For  six 
officiating.  The  Cecil  County  Medical  Society  months  subsequently  he  served  as  a  member  of  the 
met  at  the  Union  1  lospital  in  Elkton  and  attended  medical  staff  of  Bayview  Hospital.  He  was  for 
the  funeral  in  a  body.  The  pallbearers  were  Wil-  many  years  attending  physician  at  St.  Joseph's 
Ham  Pepper  Constable  of  Baltimore,  Ormond  Monastery.  St.  Mary's  Industrial  School  and 
Chaytor  of  Wilmington,  Del;  Stanley  Evans  of  Mount  St.  Joseph's  College.  Dr.  Hollyday  was 
Elkton,  and  Drs.  Robert  L.  Mitchell,  class  of  a  member  of  the  Protestant  Episcopal  Church,  but 
1905,  of  Baltimore;  II.  Arthur  Mitchell  and  became  a  convert  to  the  Catholic  Church,  and  re- 
Howard  Bratton,  both  of  Elkton.  ceived  the  last  sacrament  at  noon  the  day  before 


THE    HOSPITAL   BULLETIN 


39 


his  death.  He  married  in  [873  Miss  Virginia 
Lamar,  who  survives  him.  Mrs.  Hollyday  was 
seriously  ill  at  the  time  of  her  husband's  death, 
and  was  at  the  home  of  her  son-in-law,  Capt. 
Samuel  C.  Cardwell,  Fort  Monroe.  Dr.  Holly- 
day  had  lived  for  many  years  at  "Minnefield,"  on 
Edmondson  avenue,  extended.  He  was  a  mem- 
ber of  the  Masonic  Order,  and  was  connected 
with  main-  of  the  most  prominent  families  of  the 
Si.ue.  Besides  his  wife,  he  is  survived  by  one 
son,  Guy  Tilghman  Orme  Hollyday:  two 
daughters,  Mrs.  Virginia  Ambler  Cardwell  ami 
Miss  .Minnie  Frances  Hollyday.  and  a  sister.  Mrs. 
Thomas  F.  Billop.  He  was  buried  in  Loudon 
Park  Cemetery. 


UNDERGRADUATE  NOTES 


Under  the  Supervision  of  E.  A.  hooper. 


During  the  past  month  the  Charles  W.  Mitchell 
Medical  Society  has  been  organized,  composed 
of  40  University  students,  2^  seniors  and  15 
juniors,  with  honorary  members  from  the  faculty. 
The  object  of  the  society  is  to  stimulate  greater  in- 
terest in  the  progress  of  medical  science,  and  to 
bring  the  professors  and  students  into  closer  re- 
lationship. Meetings  are  held  each  month,  at 
which  time  certain  students  and  honorary  mem- 
bers are  called  upon  to  read  and  discuss  papers  oi 
interest  to  the  members  of  the  society.  At  the  or- 
ganization the  following  officers  were  elected: 
Dr.  Charles  Mitchell,  honorary  president:  G.  C. 
Battle,  president;  \Y.  M.  Scott,  vice-president; 
S.  E.  Buchannan,  secretary;  E.  A.  Looper,  treas- 
urer; B.  J.  McGoogan,  historian;  C.  R.  Edwards, 
correspi  mding  secretary. 

The  names  of  the  charter  members  are  as  fol- 
lows : 

Drs.  Samuel  Chew,  Chas.  Mitchell,  Hiram 
Woods,  John  C.  Hemmeter,  E.  F.  Cordell,  J.  M. 
Craighill,  Jos.  E.  Gichner,  Cordon  Wilson,  Irving 
Spear,  Chas.  McElfresh,  Jose  Hirsh,  Harry  Ad- 
ler,  W.  1 1.  Smith.  R.H.  Johnston,  H.  D.  McCarty, 
G.  C.  Lockard,  \\*.  Coleman,  H.  U.  Todd:  R.  E. 
Ahcll.  R.  A.  Allgood,  C.  C.  Cattle.  11.  A.  Bishop, 
R.  A.  Bonner,  S.  E.  Buchannan,  J.  D.  Cochran.  J. 
I).  Darby,  E.  W.  Frey,  W.  E.  Gallion,  D.  ('). 
George,  I.  E.  Hair.  M.  Hinnant,  H.  Irwin.  E.  S. 
Johnson,   E.   A.    Looper,    B.   J.    McGoogan,   \Y. 


.Michael.  W.  M.  Scott.  J.  D.  Sharpe,  E.  A.  Sher 
rill,  T.  1'".  Stevens,  C.  J.  Stallworth,  J.  Terry,  \\  . 
II.  Yeager,  J.  M.  Birch,  R.  lb  Norment,  V.  E. 
Edwards,  W.  II.  Toulson,  W.  O.  Wrightson, 
II.  J.  Slucher,  W.  II.  Scruggs,  McDaniels,  C.  R. 
Edwards,  E.  G.  Breeding,  F.  b\  Callahan,  C.  A. 
Hayworth  and  E.  D.  Murphy. 

At  the  last  meeting  of  the  University  of  Mary- 
land Medical  Society  a  very  instructive  and  en- 
tertaining lecture  on  The  Eye,  illustrated  with 
stereopticon  views,  was  delivered  by  Dr.  Hiram 
Woods.  Dr.  R.  Tunstall  Taylor  also  read  an  in- 
teresting  paper    on    the    treatment    of    Anterior 

Poliomyelitis. 

*  *         * 

Dr.  C.  B.  Williams  of  Philippi,  W.  Va.,  is  tak- 
ing post-graduate  work  at  the  University  Hos- 
pital. 

■:..         t-         * 

The  editor  of  Terra  Murine  announces  that  the 
annual  has  gone  to  press,  and  will  be  ready  for  de- 
livery May  1.  Quite  a  number  of  the  students 
have  already  engaged  copies,  and  a  large  edition 
is  being  published. 

*  *         * 

G.  H.  Lebret  and  H.  R.  Rich,  senior  students, 
have  been  sick  in  the  University  Hospital  during 
the  month,  where  they  have  undergone  opera- 
tions. 

The  University  baseball  team  opened  up  the 
season  in  Annapolis  with  a  game  against  the 
Naval  Academy.  March  20.  The  score  was  5  to  3 
in  favor  of  the  Navy. 

Several  of  the  senior  students  have  already  se- 
cured hospital  appointments  for  the  coming  year. 
Mr.  W.  II.  Yeager  has  been  appointed  superin- 
tendant  of  the  Tuberculosis  Hospital  at  Bayview, 
with  Mr.  G.  C.  Battle  as  assistant.  Mr.  E.  A. 
Sherrill  has  secured  an  appointment  in  the  surgi- 
cal department  at  Bayview,  and  Mr.  E.  P.  Kolb 
will  be  at  the  Robert  Garrett  Hospital  for  Chil- 
dren, while  Mr.  J.  D.  Darby  has  been  appointed 
resident  in  the  lying-in  department  of  the  Univer- 
sity Hospital. 

*  :!-  * 

On  March  25  the  first  regular  meeting  of  the 
Randolph   Winslow    Surgical   Society   was   held, 


40 


THE    HOSPITAL    BULLETIN 


at  which  time  two  interesting  papers  were  read 
and  discussed.  The  papers  were  "Some  Facts 
Dealing  with  the  Development  of  Aseptic  Sur- 
gery," by  R.  A.  Allgood,  and  "Surgical  Aspects 
of  Some  Tumor  Masses  Found  in  the  Neck,"  by 
Robt.  E.  Abell. 


FRATERXITIES. 

The  Kappa  Psi  Fraternity  entertained  at  its 
Chapter  House,  1415  W.  Fayette  street,  with  a 
progressive  card  party  on  Washington's  Birthday. 
Many  of  the  old  alumni  and  about  80  guests  en- 
joyed the  occasion. 

The  Chi  Zeta  Chi  annual  fraternity  dance 
was  held  at  Lehmann's  February  2$.  The  dance 
was  given  by  members  of  the  Delta  Chapter  of  the 
University,  Rho  Chapter  of  the  College  of  Phys- 
icians and  Zeta  Chapter  of  the  Baltimore  Medical 
College.  Mrs.  Nathan  Winslow  and  Mrs.  H.  U. 
Todd  were  sponsors  from  Delta  Chapter. 


IN    HONOR   OF   DR.    HIRAM    WOODS. 

The  annual  banquet  of  the  Nu  Sigma  Nu  Fra- 
ternity was  held  at  the  Hotel  Belvedere  March 
15  in  honor  of  Dr.  Hiram  Woods.  Dr.  John  C. 
Hemmeter  acted  as  toastmaster,  and  delivered  a 
paper  on  "The  Correlation  of  Medicine  and  Reli- 
gion.'' This  was  followed  by  a  series  of  talks 
relating  to  medicine  in  general  and  the  fraternity. 
Among  the  other  faculty  members  present  were 
Drs.  Hundley,  Tarun,  Hirsh,  Adler.  Taylor  and 
Spruill.  Those  from  the  Hopkins  Chapter  were 
Drs.  Ioarker,  Welch,  Finney  and  Cullen,  and  M. 
F.  Dabney,  A.  W.  Williams,  F.  Paschel  and  R. 
T.  Dotson. 


The  Baltimore  Club  of  the  Phi  Sigma  Kappa 
Fraternity  gave  its  initial  banquet  at  the  Hotel 
Rennert  Saturday  night,  March  2.  The  banquet 
was  an  extremely  pleasant  occasion,  and  was  at- 
tended by  nearly  all  of  its  alumni  members.  The 
toasts  of  the  evening  were  principally  relative  to 
the  Building  Fund  and  the  coming  convention  in 
Baltimore. 

The  speakers  of  the  evening  were  Mr.  G.  H. 
Emory,  "Law  and  Medicine":  Dr.  Vernon  B. 
Cecil,  vice-president  St.  John's  College,  "St. 
John's";  Dr.  II.  A.  Cotton,  medical  director  New 
York  State  Hospital,  "Older  Days";  Dr.  Arthur 


M.  Shipley,  professor  of  pathological  surgery  and 
materia  medica  in  University  of  Maryland,  "In- 
fluence of  Fraternities  on  Student  Life";  Mr. 
Donald  McLean,  "The  Council":  Dr.  Frank  S. 
Lynn,  "The  Coming  Convention" ;  Dr.  Nathan 
Winslow,  "The  Building  Fund":  Mr.  R.  C.  Wil- 
liams of  "Swarthmore,"  and  Mr.  W.  H.  Toulson, 
"Eta  Chapter."  Mr.  Gilbert  J.  Morgan  acted  as 
toastmaster. 


BOOK  REVIEWS 

International  Clinics.     A  Quarterly  of  Illus- 
trated   Clinical    Lectures    and    Especiallv-Pre- 
pared  Original  Articles  on  Treatment.   Medi- 
cine.  Sursjery,   Neurology,   Pediatrics.  Obstet- 
rics, Gynecology,  Orthopedics,  Pathology,  Der- 
matology, Ophthalmology,  Otology,  Rhinolog}  , 
Laryngology,  Hygiene  and  other  topics  of  in- 
terest to  students  and  practitioners.     By  lead- 
ing members  of  the  medical  profession  through- 
out the  world.     Edited  by  Henry  W.  Cattell, 
A.M.,  M.D.,  Philadelphia.     Vol.  I,  22d  series. 
1912.     Philadelphia  and  London:  J.  B.  Lippin- 
cott  Company.     Cloth,  $2  net. 
All  of  the  articles  in  the  present  volume  are 
above  the  normal  in  interest,  but  several   stand 
out  pre-eminently,  namely,  "Experimental  Polio- 
myelitis," by  Simon  Flexner,  M.D.,  of  the  Rocke- 
feller Institute  for  Medical  Research:  "The  Pres- 
ent  Status   of   Our   Knowledge   Concerning   the 
Etiology  of  Pellagra,"  by  John  Funcke,   M.D. : 
"An  Abstract  Report  of  a  Case  of  Transplanta- 
tion of  a  Testicle."  by  Levi  J.  Hammond.  M.D., 
and  Howard  A.  Sutton.  M.D..  and  "An  Account 
of  the  College  of  Physicians  of  Philadelphia,"  by 
G.  E.  de  Schweinitz,  M.D. 

As  usual,  there  is  a  wide  selection  in  the  topics 
discussed,  with  a  great  wealth  of  information  con- 
cerning the  latest  thought  in  the  various  special- 
ties. 


Some   Rough   Notes  on   Modern    Diagnostic 

Methods.     New  York  :  Fellows  Company. 

The  above  pamphlet  contains  in  abbreviate! 
form  the  essence  of  practical  laboratory  methods, 
such  as  the  technic  for  the  examination  of  blood, 
urine,  sputum,  the  Wasserman  reaction,  serums, 
vaccines,  etc.  It  is  an  extremely  useful  mono- 
graph, which  the  above-mentioned  concern  will 
gladly  furnish  upon  request  of  physicians  free  of 
charge. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 
PRICE    $1.00    PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  608  Professional  Building,  Baltimore,  Md. 


Entered  at  the  Baltimore  Fost-ofHce 
as  Second  Class  Matter 


Vol.    VIII 


BALTIMORE,  MD.,  MAY  IS,   1912. 


No.  3 


A  FRIENDLY  C<  >NTR<  >VERSY  BETWEEN 
TWO  PHYSIOLOGISTS  CONCERN- 
ING THE  MECHANISM  OF  THE 
LESSER  CIRCULATION  (RETURN 
OF  BLOOD  FROM  THE  GILLS  TO 
THE  SINUS  VENOSUS)  IN  ELASMO- 
BRANCH  FISHES. 


By  John  C.  Hemmeter,  M.D.,  Phil.D..  LL.D. 
Professor  of  Physiology,   University  of 

Maryland,  Baltimore,  Md. 


In  the  Zeitschrift  fiir  Biologiche  Technik  und 
Methodik,  Bd.  2,  p.  236,  November,  191 1,  I  pub- 
lished an  explanation  of  the  forces  that  bring  the 
blood  back  from  the  gills  to  the  sinus  venosus  in 
the  heart  of  the  selachii.  This  heart  consists  of 
sinus  venosus,  which  is  the  first  part  of  the  heart 
located  in  the  pericardium  toward  the  caudal  end  ; 
this  empties  into  the  single  auricle,  and  this  into 
the  powerful  ventricle.  The  ventricle  sends  its 
blood  through  the  bulbus  arteriosus  and  aorta  to 
the  gills. 

Whilst  the  blood  pressure  in  large  specimens 
of  dogfish,  for  instance,  may  be  very  considerable 
in  the  ventral  aorta  going  to  the  gills,  the  vessels 
returning  the  blood  from  the  gills  show  no  posi- 
tive pressure  whatever,  and  we  did  not  succeed  in 
measuring  whether  there  was  any  negative  pres- 
sure with  the  instruments  at  our  disposal  at  the 
Woods  Hole  laboratory  during  the  summer  of 
1911.  In  three  vigorous  specimens  of  mustelus 
canis  the  pressure  in  the  ventral  aorta  was  88,  92 
and  96  mm.  of  mercury,  respectively,  but  after  the 
blood  had  been  passed  through  the  fine  capillary 
network  of  the  gills  and  re-collected  again  it 
shows  no  positive  pressure  whatever;  but  there 
is  some  slight  evidence  that  the  blood  appears  t<> 
be  sucked  caudad  toward  the  sinus  venosus. 
What  causes  this  force  to  bring  back  the  blood 
from  the  gills  to  the  heart? 

The  influence  of  the  respiratory  motions  of  the 


fish  in  favoring  the  return  of  blood  to  the  sinus 
venosus  has  been  described  by  me  on  page  238 
of  the  above  article. 

But  during  a  great  many  experiments  I  noticed 
that  the  pericardium  was  a  very  tough  bag,  and 
that  it  did  not  collapse  to  any  noticeable  degree 
when  the  ventricle  contracted,  but  was  about  the 
same  size  during  the  systole  and  during  the  dias- 
tole of  the  ventricle.  The  ventricle  is  the  strong- 
est and  most  muscular  part  of  the  heart.  When 
it  contracts  it  becomes  very  much  reduced  in  size, 
but  as  the  pericardial  sac  does  not  become  smaller 
during  the  ventricular  systole,  the  thin-walled 
sinus  venosus  and  auricle  are  sucked  into  the 
space  vacated  by  the  ventricle.  In  other  words, 
there  is  a  slight  negative  pressure  created  in  the 
pericardium  when  the  auricle  and  ventricle  con- 
tract, and  this  is  filled  by  the  aspirating  into  this 
new  space  of  the  sinus  venosus.  This  negative 
pressure  is  sufficient  to  fill  the  sinus  venosus  from 
the  sinus  of  Cuvier.  At  times  the  respiratory 
muscles  of  the  fish  which  draw  the  water  into  the 
mouth  and  out  through  the  gill  slits,  contract 
simultaneously  with  the  ventricle.  Now,  in  some 
of  these  fishes  the  respiratory  muscles  (coraco 
branchial)  exert  a  traction  upon  the  pericardium, 
thus,  as  the  ventricle  gets  smaller  in  size,  cre- 
ating a  negative  pressure  in  the  pericardium, 
this  sac,  far  from  collapsing  and  following  the 
ventricle,  is  pulled  in  the  opposite  direction  by  the 
outside  traction  of  the  respiratory  muscles. 

In  the  elasmobranch  fishes  there  is  an  open 
canal  which  connects  the  pericardium  with  the 
peritoneum,  known  as  the  pleuro-peritoneal  canal 
I  pericardio-peritoneal  canal  would  be  a  more 
correct  designation),  which  drains  the  pericar- 
dium toward  the  peritoneum;  owing  to  valves  in 
this  canal,  however,  no  fluid  can  enter  from  the 
peritoneum  into  the  pericardium.  Therefore,  a 
negative  pressure  is  possible  in  the  pericardium, 
but  not  a  positive  pressure,  for  if  a  positive  pres- 
sure were  ever  created  in  anv  conceivable  manner 


4-' 


THE   HOSPITAL   BULLETIN 


it  would  be  spent  toward  the  peritoneum  through 
this  canal.  Delicate  water  manometers  tied  into 
the  abdominal  side  of  this  canal  indicate  always 
a  slight  negative  pressure  with  each  systole  of 
the  ventricle;  never  a  positive  pressure. 

So  the  explanation  I  offered  was  that  the  re- 
turn of  blood  toward  the  sinus  venosus  from  the 
gills  was  clue  to  a  negative  pressure  in  the  peri- 
cardium caused  in  the  manner  described.  When 
I  explained  this  mechanism  to  my  friend,  Frof. 
G.  H.  Parker,  who  was  working  in  the  same 
laboratory  (that  of  the. United  States  Fish  Com- 
mission at  Woods  Hole,  Mass.),  he  informed  me 
that  this  discovery  had  already  been  made  by 
Leon  Fredericq  at  Liege,  and  in  the  article  writ- 
ten by  me  I  credited  Fredericq  with  having  first 
explained  the  respiratory  circulation  in  the  fish 
and  the  return  of  blood  to  the  heart  in  this  man- 
ner. On  the  8th  of  February,  1912,  I  received 
the  following  letter  from  Professor  Fredericq : 

"Most  Honored  Colleague — I  have  read  in  a 
very  interesting  article  by  you  ( 'Methodik  der 
Gleichzeitigen  Registrierung  des  Atmungs-  und 
Herzrythmus  beim  Selachier')  in  the  Zeitschrift 
fiir  Biologiche  Technik  und  Methodik,  Novem- 
ber, 1 9 1 1 ,  p.  2T,(>,  a  description  of  a  method  con- 
cerning the  return  of  blood  from  the  gills  to  the 
sinus  venosus  in  the  fish  which  you  credit  to  me. 
You  will  oblige  me  very  much  by  indicating 
where  you  have  found  this  method  described,  as 
I  cannot  recall  having  published  anything  con- 
cerning this  subject.  In  expressing  my  thanks 
in  advance,  will  you  please  accept  the  assurance 
of  my  most  cordial  sentiment  ? 

"Leon  Fredericq. 

"P.  S. — You  may  reply  in  English  or  German, 
just  as  you  prefer." 

Thereupon  I  communicated  again  with  Pro- 
fessor Parker,  who  sent  me  the  following  letter: 

"Dear  Dr.  Hemmeter — The  idea  I  had  about 
the  return  of  blood  to  the  heart  of  a  fish  applied 
to  those  cases  where,  as  in  the  skate,  the  walls 
of  the  pericardium  are  firm.  My  notion  was  that 
the  contraction  of  the  ventricle  in  a  firm-walled 
chamber  would  of  necessity  cause  the  auricle  to 
fill  by  sucking  in  blood  from  the  venous  sinus, 
etc.  Such  a  condition  would  imply  a  negative 
pressure  in  the  blood  cavities  immediately  behind 
the  heart.  I  remember  talking  this  over  with  Dr. 
Willem  at  Naples,  and  he  told  me  that  this  nega- 
tive   pressure    had    been    demonstrated    by    Leon 


Fredericq  at  Liege  for  certain  fishes.  This  con- 
versation was  in  1893,  and  the  whole  affair  is  nat- 
urally somewhat  hazy  to  me  now,  but  I  believe 
I  never  knew  whether  these  observations  of 
Frederick's  were  published  or  not.  I  am  sorry 
I  can't  send  you  more  satisfactory  information. 

"Spaeth  and  I  have  just  completed  a  hard  half- 
year's  work,  and  we  are  beginning  to  feel  more 
ourselves  again.  With  kind  regards  to  Mrs. 
Hemmeter,  I  am, 

"Very  truly  yours. 

"<  1.  H.  Parker. 
"Zoological  Laboratory,  Harvard  University. 

"Cambridge,  Mass.,  February  13,  1912." 

(  )n  receipt  of  this  letter  from  my  friend.  Dr. 
Parker,  I  sent  the  following  communication  to 
Professor  Fredericq : 

"Baltimore,  February  15.  191 2. 
"M.  le  Professeur  Leon  Fredericq: 

"My  Dear  Colleague  and  Honored  Friend — 
From  the  error  I  have  made  in  my  article  0:1 
'Methodik  der  Gleichzeitig.  Registrierung.'  etc.. 
in  the  Zeitschr.  f.  Biologic.  Technik.,  Hft.  5.  Bd. 
2,  November,  191 1,  p.  236,  attributing  to  yourself 
a  physiologic  contribution  which  you  say  that  you 
have  never  published,  you  will  recognize  one  of 
the  embarrassing  accompaniments  of  your  great- 
ness, for  discoveries  are  credited  to  you  which 
you  have  never  made. 

"(  )n  the  other  hand,  the  error  slmws  what  un- 
desirable complications  we  may  be  led  into  by 
overconfidence  in  our  friends  whom  we  know  as 
great  authorities.  Inclosed  I  hand  you  a  letter 
from  my  friend,  Prof.  G.  H.  Parker,  professor  of 
zoology  at  Harvard  University,  Cambridge. 
Mass. 

"Parker  worked  in  the  Marine  Biological 
Laboratory  at  Woods  Hole,  Mass.,  all  of  last 
summer,  and  I  asked  him  about  this  very  physio- 
logic question  concerning  the  return  of  blood 
from  the  gills  to  the  heart  in  fishes,  and  he  gave 
me  to  understand  that  you  had  done  this  work. 
Knowing  Parker  to  be  one  of  the  greatest  zoolo- 
gists of  our  country  and  a  very  thorough  and 
broadly-educated  man,  I  did  not  doubt  his  state- 
ment, nor  did  I  take  the  trouble  to  look  up  any 
reference  on  the  subject. 

"As  I  was  teaching  your  contributions  t"  res- 
piration to  my  students  every  year,  it  seemed  ^,, 
natural  and  self-evident  that  you  should  also 
have  made  this  discovery  on  fishes.     If  you  desire 


THE    HOSPITAL    BULLETIN 


43 


me  to  correct  this  error,  I  will  send  a  letter  to  that 
effect  to  Prof.  .Martin  Gildem'eister,  the  editor  of 
the  above  Zeitschrift. 

"I  may  add  that  this  mechanism  of  the  nega- 
tive pressure  created  in  the  pericardium  of  the 
elasmobranchs  during  the  contraction  of  the  au- 
ricle and  ventricle  was  worked  out  by  me  at 
Woods  Hole  last  summer,  and  I  did  not  claim  it 
as  an  original  piece  of  work,  because  Parker 
stated  thai  you  had  already  made  this  discovery. 
As  you  now  disclaim  ever  having  done  such 
work,  it  will  be  best  for  me  to  publish  my  experi- 
ments on  this  subject. 

By  invitation  of  Prof.  11.  J.  Hamburger  I  hope 
to  be  in  Groningen  next  fall  to  attend  the  meet- 
ing of  the  International  Physiologic  Society. 
Perhaps  I  will  have  the  pleasure  of  seeing  yon 
and  meeting  you  there. 

"My  new  work.  'Manual  of  Physiology,"  was 
published  this  week  in  Philadelphia.  Can  you 
tell  me  the  exact  date  of  the  meeting  of  physiol- 
ogists in  ( ironingen  ? 

"Hoping  you  are  well,  and  with  kindest  re- 
gards. ]  am, 

"Yours  very  sincerely, 

"J.  C.  Hemmeter. 
"739  University  Parkway, 

"Roland  Park,  Baltimore." 

On  March  io,  1912,  I  received  the  following 
reply  from  Professor  Fredericq : 

"Institute   of    Physiology,    LTiiversity   of    Liege, 

"February  29,  191 2. 

"My  Dear  Colleague  Hemmeter — Thank  you 
for  your  kind  letter.  Herewith  I  return  Profes- 
sor Parker's  letter.  I  cannot  imagine  how  1  )r. 
Willem  could  have  made  the  mistake  of  attrib- 
uting to  me  merits  which  I  do  not  possess.  In- 
deed, I  have  never  undertaken  any  work  on  the 
circulation  of  bony  fish.  With  regard  to  other 
fish,  I  limited  myself  to  the  collection  of  blood, 
but  never  made  any  experiments  in  the  circulatory 
mechanism. 

"It  does  not  seem  worth  while  to  trouble  you 
with  writing  a  correcting  article.  You  will  cer- 
tainly have  the  opportunity  of  some  day  correct- 
ing this  pi  lint,  which  is  of  no  importance  to  me. 
in  your  future  publications. 

"I  am  glad  of  the  opportunity  which  brought 
us  in  contact  with  each  other,  and  hope  to  have 
the  pleasure  of  meeting  you  in  Groningen  in  1913. 

"Your  friend.  Professor  Hamburger,  has  been 


to  see  me  at  Liege  last  week.  I  le  told  me  of  your 
splendid  work  and  that  the  congress  opens  the 
first  Tuesday  in  (  (ctober,  1913. 

"Yours  very  devotedly, 

"I  J  1  IN   Frederk  q." 

I  publish  this  correspondence  not  simply  be- 
cause it  authorizes  me  to  publish  under  my  own 
name  an  important  contribution  to  the  compara- 
tive physiology  of  the  circulation,  but,  what  I 
esteem  far  higher,  it  gives  evidence  of  the  high- 
minded  manner  in  which  men  with  warm,  sane 
hearts  adjust  their  differences.  Ton  frequently 
we  see  men  who  claim  extraordinary  mental  cul- 
ture attack  their  confreres  in  a  disingenious  man- 
ner calculated  to  injure  their  good  name  and  self- 
respect. 

The  correspondence  with  Professor  Fredericq 
illustrates  how  leaders  of  thought  in  natural 
science,  if  they  are  true  lovers  of  science,  will 
naturally  observe  the  "Golden  Rule." 


Among  the  alumni  elected  to  official  positions 
at  the  last  meeting  of  the  Medical  and  Chirurgical 
Faculty  are : 

President — Dr.  Archibald  Cunningham  Harri- 
son, class  of  1887,  of  Baltimore,  Md. 

Vice-President  —  Dr.  Charles  Fitzsimmons 
Davidson,  class  of  1888,  of  Easton.  Md. 

Alternate  to  American  Medical  Association — 
Dr.  William  Royal  Stokes,  class  of  1891,  of  Bal- 
timore. Md. 

Councillors — Dr.  Josiah  Slicer  Bowen,  class  of 
1903,  of  Mt.  Washington,  Md.,  and  Dr.  Guy 
Steele,  class  of  181)7,  ot  Cambridge,  Md. 

Committee  on  Scientific  Work  —  Dr.  Arthur 
Marriott  Shipley,  class  of  1902,  of  Baltimore.  Md. 

Library  Committee — Dr.  John  Whitridge  Wil- 
liams, class  of  1888;  Dr.  Ridgeley  Brown  War- 
field,  class  of  1884,  and  Dr.  Carey  Breckinridge 
Gamble,  Jr.,  class  of  1887,  all  of  Baltimore. 

Trustee  Finney  Fund  for  Three  Years — Dr. 
Samuel  T.  Earle.  Jr..  class  of  1870.  of  Baltimore. 


We  would  be  glad  to  know  the  present  loca- 
tions of  Dr.  Max  Joseph  Fiery,  class  of  1910;  Dr. 
Frank  Paul  Firey,  class  of  1910;  Dr.  Lafayette 
Lake,  class  of  1906;  Dr.  Eugene  P..  Howie,  class 
of  1910,  and  Dr.  John  Edgar  Rooks,  elas-  of  v  >•  -. 


44 


THE   HOSPITAL   BULLETIN 


THE   FUNCTIONS   OF  AN   ALUMNI   AS- 
SOCIATION.* 


By  William  Herbert  Pearce.  M.D.,  'gi. 


Mr.  President,  Ladies  and  Gentlemen — 'When 
I  received  the  invitation  extended  me  by  the 
Chairman  of  your  Committee,  Mr.  Baker,  to 
respond  to  a  toast  on  this  occasion,  I  was  em- 
barrassed by  its  flattering  character. 

After  the  initial  intoxication  of  this  signal 
honor  had  subsided,  however,  I  began  to  ask 
myself  what  it  all  meant.  Why  should  I  be 
asked  to  address  Dickinson  Alumni  ?  I  am  not 
a  graduate  of  Dickinson ;  I  never  got  out  of  her 
Prep.  School.  Like  Ben  Tillman,  I  am  a  product 
of  the  cornfield.  The  feeling  that  there  was  a 
sinister  motive  back  of  this  flattering  honor 
haunted  me.  I  found  myself  vacillating  between 
gratulation  and  '  apprehension — one  moment 
gloating  over  the  realization  of  a  long  cherished 
ambition,  and  the  next,  crouching  with  fear  at 
the  forebodings  of  an  evil  omen.  For  a  moment, 
when  buoyed  up  by  the  hope  of  preferment,  I 
recalled  President  Woodrow  Wilson's  declaration 
that  the  most  interesting  men  he  had  ever  met 
were  not  college  graduates.  Then  those  words 
of  Darwin  came  to  me — "I  barely  escaped  the 
blighting  influence  of  Cambridge."  And  I  thought 
of  Herbert  Spencer — the  supreme  man  of  our 
age — who  refused  to  subject  his  imperial  intellect 
to  the  levelling  influence  of  college  routine,  and 
foreordained  conformity. 

In  this  state  of  exaltation  I  said,  "At  last  the 
colleges  are  beginning  to  recognize  merit  out- 
side their  fold."  This  period  of  hopefulness  was 
short-lived,  and  I  again  sank  into  the  slough  of 
despond,  concluding  I  had  been  tricked.  In  sheer 
desperation  I  went  to  my  old  friend,  Dr.  Taney - 
hill — that  incomparable  generalissimo  of  confused 
situations — and  pleaded  with  him  to  reveal  the 
secret  that  actuated  his  committee,  and  this  is 
what  he  told  me:  "You  know."  said  he,  "the 
Alumni  of  Dickinson  College,  as  a  class,  are  so 
given  to  self-depreciation  and  to  such  excesses  of 
modesty  that  both  they  and  their  Alma  Mater 
have  suffered  as  a  consequence.  The  graduates 
of  other  colleges.  Harvard,  Yale,  Princeton,  Co- 
lumbia, Hopkins,  Chicago,  and  all  the  rest,  are  so 
proud  of  their   respective  Alma   Maters  that   in 


•An  address  delivered  at  the  annual  banquet  of  the  riickin- 
siui  College  Alumni  Association,  February  11.  1910,  at  the  Hotel 
Rennert,  Baltimore,  Mil. 


their  attitude  toward  each  other  and  the  world 
they  display  the  most  disdainful  hauteur.  "Not 
so  with  the  Alumni  of  Dickinson,"  he  continued, 
"they  disparage  their  own  achievements — de- 
preciate their  own  motives,  and  discredit  their 
own  professions."  When  I  inquired  how  he  ac- 
counted for  this  anomalous  situation  he  replied, 
"You  know  association  begets  assimilation,  and 
we  attribute  it  to  the  modesty  of  Dickinson's 
President.  Now,  in  order  to  remedy  this  defect 
in  the  character  of  our  Alumni,  our  Committee 
suggested  asking  you,  for  the  sake  of  contrast, 
to  speak  with  real  bona  fide  Alumni,  that  they 
might  furnish  an  object  lesson  in  the  great  advan- 
tages that  accrue  to  our  graduates,  whereby  they 
hoped  to  inspire  in  the  modest  sons  of  this  noble 
Mother,  a  laudable  pride  both  in  her  and  in 
themselves."  "Then,"  said  I,  "your  proposal  is 
to  make  a  fool  of  me  in  order  to  create  a  grate- 
ful consciousness  in  your  Alumni."  "Exactly 
so,"  said  he ;  "we  believed  you  to  be  a  man  of 
benevolent  impulses,  and  surely  there  can  be 
nothing  worthier  than  the  sacrifice  of  one's  self 
for  the  happiness  of  others."  When  I  protested 
that  I  had  had  no  experience  in  making  a  fool 
of  myself — since  I  got  married — and  did  not 
know  how  to  proceed,  he  replied,  "Be  natural." 
This,  ladies  and  gentlemen,  explains  why  an 
undergraduate  Prep,  is  inflicted  upon  you  to- 
night. 

While  it  is  true  that  I  never  got  out  of  the 
Prep.  School,  I  am  free  to  confess  that  two  boy- 
ish dreams  overshadowed  every  other  ambition 
that  crossed  my  youthful  pathway.  One  was  to 
become  a  graduate  of  Dickinson,  and  the  other, 
to  be  a  Methodist  preacher.  Both  of  these  worthy 
ambitions  were  traceable  to  a  devoted  Mother, 
who  was  as  noble  in  character  as  she  was  ex- 
alted in  her  aspiration  for  me.  When  a  mere 
child  she  took  me  to  the  Methodist  Church  and 
held  up  to  me  as  models  those  preachers  who 
had  been  trained  at  Dickinson.  Well  do  I  recall 
her  admiration  for  George  Bacon  and  Fred 
Heisse.  They  were,  to  my  childish  imagination, 
the  Bossuet  and  Massillon  of  the  American  pul- 
pit. But  a  fuller  appreciation  of  the  transcendent 
thaumaturgical  power  of  Dickinson  was  realized 
at  a  later  period.  Though  still  a  small  boy,  well 
do  I  remember  when  the  distinguished  President 
of  your  Baltimore  Association —  Dr.  Wilbur  M. 
Pearce.  went  to  college.  I  had  known  him  as  the 
son  of  a  farmer,  and  had  always  thought  of  him 


TH1L   HOSPITAL   BULLETIN 


45 


as  belonging  to  a  similar  sphere  to  that  in  which 
1  had  been  born.  He  went  forth  from  among 
us  a  typical  country  lad,  and  you  can  imagine 
my  surprise,  amazement  and  consternation  when, 
two  years  later,  lie  returned  caparisoned  in  all 
the  habiliments  of  the  ultra-fashionable,  draped 
in  a  long-tailed  broadcloth  coat,  and  crowned  with 
a  stove-pipe  hat — not  made  to  shine — but  shin- 
ing himself  in  a  mannerism  that  would  have  put 
to  shame  Beau  Brummel,  or  Harry  Lehr.  As 
T  gazed  upon  his  resplendent  form.  I  said  to 
myself,  "Great  is  Dickinson!"  I  was  unsophisti- 
cated enough  to  believe  that  this  external  trans- 
formation had  been  accompanied  by  a  corre- 
sponding internal  metamorphosis.  Is  it  surpris- 
ing that  Dickinson  should  have  become  for  me 
the  hub  of  the  universe?  To  Dickinson  I  deter- 
mined to  go. 

I  landed  in  the  Prep.  School  just  before  Presi- 
dent Reed  made  his  debut  in  Carlisle.  I  shall 
never  forget  my  first  impression  of  the  new 
President.  In  after  life  there  are  but  few  things 
more  amusing  than  the  first  impressions  of  our 
juvenile  period.  I  can  better  convey  to  you, 
perhaps,  this  juvenile  idea  by  an  illustration, 
rather  than  a  description.  Dr.  Johnson,  the  great 
Sultan  of  English  literature,  was  once  standing 
on  a  street  corner  in  London,  conversing  with 
David  Garrick,  the  celebrated  actor,  when  Bishop 
1  I.  Tsley  drove  by  with  gay  and  brilliant  equipage, 
that  flashed  and  spun ;  whereupon  Garrick  re- 
marked :  "There  goes  Bishop  Horsley,  looking 
as  though  he  might  say  to  one  of  the  Apostles, 
'Here,  Sir,  hold  my  horses.'  " 

Shortly  after  Dr.  Heed's  arrival  in  Carlisle  it 
was  announced  that  standards  were  to  be  raised, 
and  that  only  men  of  large  mental  calibre  would 
be  able  to  measure  up  to  the  new  requirements. 
The  wisdom  of  my  withdrawal  was  hinted  at,  and 
finally  a  committee  of  commiseration  waited  upon 
me  and  advised  me  to  discontinue  my  studies,  and 
return  to  the  farm,  adding  that  I  was  wasting 
both  my  time  and  my  father's  money.  In  ex- 
tenuation, they  further  suggested  that  I  become 
an  agricultural  specialist.  "For,"  said  they,  "it  is 
evident  that  Nature  has  better  equipped  you  for 
gathering  apples   than  picking  potato-bugs." 

The  toast  to  which  1  am  to  respond  is.  The 
Functions  of  an  Alumni  Association.  While 
it  is  true  that  I  have  no  Collegiate  Mother,  I 
have  a  Medical  Mother,  and  from  my  relation- 
ships to  her  have  been  derived  those  experiences 


that  form  that  basis  of  my  remarks.  When  we  re- 
flect upon  the  debt  of  gratitude  that  each  of  us  owe 
our  Alma  Mater  it  seems  strange  to  suggest  that 
we  need  a  memorial  of  her;  and  yet  this  is  the 
most  important  function  of  an  Alumni  Associa- 
tion. We  are  ever  prone  to  forget — to  forget  the 
best  things  of  life.  Even  Jesus  of  Nazareth 
found  it  necessary  to  leave  a  memorial  of  Him- 
self to  His  disciples.  In  reference  to  the  Holy 
Eucharist,  He  said,  "This  do  in  remembrance 
of  Me." 

Bernard  Shaw,  in  his  great  drama  of  Caesar 
and  Cleopatra,  in  the  farewell  scene,  makes 
Caesar  forget  even  the  all-conquering  Cleopatra. 
The  profoundest  emotions  that  stir  the  soul  of 
man  are  soon  forgotten. 

"Never  a  tear  bedims  the  eye, 

That  time  and  patience  will  not  dry." 

It  is  necessary,  in  order  to  preserve  the  most 
priceless  things  in  life,  in  some  way  to  memorialize 
them.  To  appreciate  the  importance  of  a  Me- 
morial to  our  Alma  Mater,  one  has  but  to  reflect 
upon  the  inspiring  influence  that  great  teachers 
make  upon  our  whole  career.  Who  shall  measure 
the  influence  of  such  men  as  Werner  at  Freiburg, 
Dollinger  at  Munich,  Arnold  at  Rugby,  Tappan 
at  Ann  Arbor,  Hopkins  at  Williamstown,  White 
at  Ithaca,  and  Agassiz  at  Cambridge. 

Air.  Emerson,  in  writing  to  his  daughter,  said, 
"It  makes  little  difference  what  your  studies  are, 
it  all  lies  in  who  your  teacher  is."  President 
David  Starr  Jordan  says,  "In  my  own  education 
nothing  meant  so  much  to  me  as  contact  with  a 
few  great  men  whom  I  knew  face  to  face."  These 
words  of  President  Jordan  are  a  rehearsal  of  a 
chapter  of  my  own  experience.  When  I  entered 
the  halls  of  my  Alma  Mater,  eyes  I  had,  but  saw- 
not — ears,  but  heard  not,  and  on  njy  slumberous 
soul  rested  the  weary  weight  of  all  this  unin- 
telligible world.  I  knew  not  the  power  of  har- 
mony and  the  deep  power  of  joy  that  reveal  the 
life  of  things,  until  my  heart  had  been  fired  to 
flame  by  the  concentrated  influences  of  my  Alma 
Mater.  Within  her  sacred  walls  I  had  a  new 
birth — an  intellectual  renaissance ;  aye,  the  con- 
scious palingenesis  of  my  whole  psychic  being; 
here  my  soul  began  to  expand  like  a  flower  open- 
ing to  the  light.  Through  her  I  was  admitted 
to  the  arcana  of  Nature — made  to  feel  a  kinship 
with  the  remotest  star,  and  at  home  with  the 
journeying  winds.  The  horizon  of  my  certain- 
ties was  widened  and  separated  by  a  firmer  line 


46 


THE   HOSPITAL   BULLETIN 


from  the  impalpable  obscure  that  surrounds  us 
on  every  side.  To  her  I  owe  the  inspiration  of 
all  those  swirling  eddies  of  thought  that  have 
engulphed  my  eager  spirit  in  the  lure  of  the 
Questioning  Infinite  that  bends  over  us  and  throbs 
about  us.     From  her — 

*     *     *     "I  have  learned 

To  look  on  Nature,  not  as  in  the  hour 

Of   thoughtless    youth ;    but    hearing   oftentimes 

The  still  sad  music  of  humanity." 

The  second  function  of  an  Alumni  Association 
is  the  advancement  of  the  interests  of  our  Alma 
Mater.  There  are  relatively  few  Alumni  that 
are  able  to  make  financial  contributions  to  their 
Alma  Mater,  but  it  is  in  the  power  of  every 
Alumnus  to  render  her  valuable  service.  Mr. 
Eeecher  once  said,  "There  comes  a  time  in  every 
man's  life  when  nothing  can  take  the  place  of 
friends."  This  statement  is  just  as  true  when 
applied  to  institutions  as  it  is  to  individuals. 

A  word  of  commendation  or  an  expression  of 
confidence  not  infrequently  yields  large  returns. 
I  personally  feel  that  a  plea  for  Dickinson  Col- 
lege can  be  made  upon  the  highest  possible 
grounds.  So  far  as  I  know,  she  has  not  a  James, 
or  a  Royce,  a  Dewey,  or  a  Giddings,  a  New- 
combe,  or  a  Gildersleeve :  but  she  has  an  asset 
more  valuable  than  each  or  all  of  these  to  the 
formative  period  of  youth,  and  that  is  an  atmos- 
phere of  morality  more  distinctive  than  that  of 
the  Universities  manned  by  these  great  teachers. 
YVe  live  in  an  age  that  is  insane  on  the  subject 
of  intellectual  education,  and  one  that  almost 
whoHy  ignores  that  which  is  of  infinitely  greater 
importance — moral  discipline.  Herbert  Spencer 
acutely  observes,  "The  intellect  is  but  the  servant 
— th':  emotions  are  the  masters."  The  need  of 
the  hour  is  discipline  of  the  feelings — we  are  fast 
becoming  a  nation  of  neurasthenics.  Support 
your  Alma  Mater — her  atmosphere  has  moral 
tone. 

A  third  function  of  an  Alumni  Association 
is  the  preservation  of  the  friendships  of  our  stu- 
dent days.  It  is  not  without  valid  reason  that 
the  friendships  of  this  period  should  be  guarded 
more  carefully  than  that  of  any  other.  All  of 
the  true,  permanent  and  unselfish  friendships  of 
life  are  formed  in  youth.  In  the  attachments  of 
a  later  period  we  cannot  avoid  the  alloy  of  selfish- 
ness. I  care  not  how  much  certain  personalities 
may  attract  us,  it  is  impossible  to  exclude  from 


consciousness  the  idea  of  reciprocity.  It  is  only 
in  the  joyous  exuberance  of  youth  that  our  spirits 
unconsciously  respond  to  all  that  is  best  in  the 
yearnings  of  kindred  natures.  Our  college  days 
not  only  constitute  the  period  when  the  stable 
friendships  of  life  are  formed,  but  they  furnish 
also  the  conditions  most  favorable  for  the  growth 
of  genuine  attachments. 

In  Agassiz's  eulogy  of  Humboldt  he  gives  an 
impressive  account  of  the  influence  that  trained 
men  exert  upon  each  other.  "What  a  rendezvous 
for  the  initiated  was  Agassiz's  own  chamber  in 
the  University  of  Munich !  Here  in  one  room  was 
a  museum,  a  laboratory,  a  library,  a  bedroom,  a 
dining-room,  and  a  fencing- room.  Professors 
and  students  alike  called  it  "The  little  Academy." 
Here  they  worked  and  talked  and  thought,  shar- 
ing not  alone  the  discoveries  of  the  mind,  but 
dividing  also,  with  cheerful  generosity,  their  scant 
meals  and  slender  earnings. 

The  friendships  cemented  in  college  life  alone 
are  a  sufficient  justification  for  its  existence. 
President  Jordan  well  says,  "In  college  you  find 
the  men  you  trust  in  after  life,  and  one  who 
does  not  fail  you  then  will  never  after  give  you 
cause  for  regret." 

The  fourth  and  last  function  of  an  Alumni 
Association  I  shall  enumerate  is  keeping  alive  the 
college  spirit.  There  is  among  college  men  an 
esprit  de  corps  that  we  call  college  spirit,  which 
is  produced  by  the  distinctive  atmosphere  of 
college  life.  Four  hundred  years  ago,  in  the  old 
University  of  Greifswald,  Ulrich  Von  Hutton 
defined  the  college  spirit  as  "Gemeingeist  unter 
freien  Geistern,"  comradeship  among  free  spirits. 
Comradeship  embraces  the  intimacy  of  friendly 
relations,  and  implies  the  pursuit  of  similar  ac- 
tivities. The  word  in  its  derivation  denotes 
chamber-mate — the  living,  as  it  were,  a  common 
life.  It  is  in  the  intimacy  of  human  intercourse 
that  the  highest  values  of  life  inhere. 

George  Eliot,  in  writing  to  a  friend,  says: 
"There  is  nothing  half  so  sweet  in  life  as  the 
delicious  new  friendship  I  have  formed  for  Mr. 
Herbert  Spencer :  we  have  a  delightful 
camaraderie  in  everything."  The  college  spirit  is 
more  than  comradeship ;  it  is  comradeship  among 
free  spirits.  The  true  picture  of  the  college  spirit 
is  that  of  co-workers  sedulously  searching  for 
truth  ;  for  it  is  knowledge  of  the  truth  that  makes 
free.  "Ye  shall  know  the  truth,  and  the  truth 
shall  make  you  free,"  said  Jesus.     Is  it  not  in 


THE    HOSPITAL    BULLETIN 


47 


freedom  from  ignorance,  selfishness  ami  vice  that 
we  find  abundance  of  life?  Is  there  not  need  in 
the  world  of  this  college  spirit?  The  mission  of 
the  scholar  is  not  in  seclusion,  but  in  the  currents 
of  life. 

Though  the  avenues  of  after  life  lead  in  di- 
verging directions,  it  is  possible  through  Alumni 
Associations  and  annual  reunions  to  cherish  the 
memory  and  advance  the  interests  of  our  Alma 
Mater — to  preserve  the  friendships  of  our  student 
days — tn  keep  alive  the  college  spirit,  and  in 
sweet  memory  to  tread  again  the  paths  we  loved 
so  well  in  the  long  ago. 

"Each  fainter  trace  that  memory  holds, 

So  darkly  of  departed  years, 
In  one  broad  glance- the  soul  beholds, 

And  all  that  was,  at  once  appears." 


-PELLAGRA. 


Edw.  A.  Looper,  Senior  Student. 


The  first  authentic  description  of  pellagra  was 
made  in  1762  by  Gasper  Casal,  a  Spanish  phy- 
sician, who  gave  it  the  name  of  Alal  de  la  Rosa. 
As  early  as  1735  he  observed  this  peculiar  affec- 
tion among  the  peasants  of  the  Asturias,  but  his 
writings  were  not  published  until  after  his  death 
in  1762,  by  Joseph  Gracia. 

Trapolli  of  Milan  is  credited  with  having  given 
the  disease  its  present  name,  in  1771,  pellagra 
( Ital.  pelle,  skin;  agra,  rough.) 

From  the  articles  of  the  long  list  of  authors 
from  that  time  down  to  the  present  the  progress 
of  the  disease  can  be  traced  throughout  Europe, 
from  Spain  to  Southern  France,  from  Italy  to 
Upper  Egypt,  in  parts  of  Africa,  Austria,  Servia, 
Bulgaria.  India,  Mexico,  Barbadoes  and  certain 
areas  of  North  and  South  America.  Italy  seems 
to  have  suffered  more  from  the  ravages  of  the 
disease  than  any  of  the  other  European  countries. 
At  one  time  it  was  estimated  that  one  in  every 
nineteen  of  the  inhabitants  in  Northern  and 
Central  Italy  suffered  with  the  disease. 

Pellagra  has  been  known  to  exist  in  the  United 
States  less  than  30  years,  but  its  increase  has 
been  so  rapid  and  prevalence  so  far  reaching 
that  it  has  become  one  of  the  gravest  problems 
in  the  South  today.  Cases  have  been  reported 
in  30  States  of  the  Union,  with  the  greatest  num- 


•Read  before  Mitchell  Medical  Society,  April  4,  1912 


bers  in  Georgia,  North  and  South  Carolina,  Ken- 
tucky and  Tennessee,  where  the  warm  climate 
undoubtedly  plays  a  prominent  part  in  its  greater 
prevalence. 

Etiology. —  The  cause  of  pellagra  has  as  yet 
not  been  definitely  determined ;  however,  several 
theories  have  been  projected,  the  older  of  which 
is  the  Zeistic  theory,  whose  adherents  claim  that 
damaged  maize  is  in  some  way  responsible  for 
the  malady. 

Neusser  contends  that  the  poisonous  principle 
is  toxico-infectious  in  character,  and  is  developed 
by  the  action  of  the  bacterium  maidis  upon  dam- 
aged or  fermented  maize. 

Lombroso  claims  to  have  produced  similar 
symptoms  to  pellagra,  experimentally,  in  animals 
by  injecting  them  with  a  toxine  produced  by  the 
action  of  certain  fungi  and  aspergilli  upon  fer- 
mented maize. 

Much  evidence  has  been  given  for  and  against 
the  Zeistic  theory,  but  at  present  it  is  undoubtedly 
losing  ground,  becoming  supplanted  by  the  idea 
that  the  disease  is  due  to  a  specific  parasite. 

In  1910  Lombroso  reported  that  his  experi- 
ments and  researches  in  Italy  had  led  him  to 
believe  that  pellagra  was  caused  by  the  sand- 
fly or  buffalo-gnat,  and  was  a  definite  parasitic 
disease.  His  theory  is  based  upon  several  im- 
portant facts  and  has  gained  many  adherents. 

Mizell,  in  1911,  formulated  the  theory  that  a 
cotton-seed  poison  was  responsible  for  the  infec- 
tion, and  produced  its  affects  by  nutritional  dis- 
turbances. Whatever  the  exciting  cause  may  be, 
it  is  an  indisputable  fact  that  the  impoverished 
condition  of  large  masses  of  people,  poor  hygienic 
surroundings,  alcoholic  excesses  and  exposure  to 
the  sun's  rays,  are  undoubtedly  important  pre- 
disposing factors.  Any  age  may  be  affected,  but 
most  cases  have  been  reported  in  adult  life  from 
the  third  to  the  fifth  decade.  In  America  women 
have  seemed  more  susceptible  than  men.  The 
first  manifestation  of  the  disease  is  usually  in 
the  spring  months.  The  warmer  climates  afford 
the  principal  territories  for  greatest  development 
of  the  disease.  Pellagra  is  certainly  not  infec- 
tious, contagious  nor  inherited. 

Symptoms. — There  are  two  varities  of  pel- 
lagra, the  acute  and  chronic  form ;  the  latter  is 
the  common  variety,  and  the  one  usually  de- 
scribed. 

The  symptoms  may  be  divided  according  to 
the   systems   most   generally   affected,    viz. :   dis- 


48 


THE   HOSPITAL   BULLETIN 


turbances  in  the  gastrointestinal  tract  and 
cerebro-spinal  system,  and  the  characteristic  skin 
manifestations,  erythemato-squamous  and  pig- 
mentary in  character. 

The  appearance  of  the  disease  is  usually  in  the 
spring  months,  the  onset  being  insiduous,  and 
frequently  preceded  for  several  weeks  by  a  pro- 
dromal period  in  which  the  patient  experiences 
an  increasing  sensation  of  languor  and  general 
malaise,  followed  by  increasing  weakness  and  loss 
of  interest  in  things,  with  neglect  of  customary 
duties  and  dread  of  exertion. 

The  first  complaint  is  usually  of  some  gastro- 
intestinal disturbance,  which  may  manifest  itself 
lnr  anorexia,  burning  sensation  in  epigastrium, 
excessive  desire  for  drink,  and  often  an  associated 
diarrhea,  stomatitis  and  not  infrequently  exces- 
sive secretion  of  saliva  simulating  ptyalism.  The 
tongue  may  be  red  and  coated,  with  prominent 
papillae.     Nausea  and  vomiting  is  apt  to  ensue. 

Tenderness  along  the  spine  and  pain  in  the 
back  is  frequently  complained  of.  The  tempera- 
ture may  remain  normal  through  the  disease,  but 
cases  have  been  reported  where  the  temperature 
was  subnormal,  and  in  others  it  ran  from  102°- 
ro8°.  The  pulse  is  usually  elevated  from  80-160. 
The  diarrhea  is  characteristically  obstinate,  re- 
sisting- all  medication  and  dietary  correctives. 

The  characteristic  manifestations  of  pellagra 
are  the  cutaneous  phenomena,  which,  according 
to  Stelwagon,  may  be  divided  into  three  stages — 
the  first,  a  congestion  or  erythema;  the  second, 
with  added  scaliness,  thickening  and  pigmenta- 
tion ;  and  the  third,  a  tendency  to  atrophic  thin- 
ning. 

The  first  stage  of  the  eruption  usually  makes  its 
appearance  in  the  early  spring,  developing  rather 
suddenly,  with  symmetrical  distribution  of  an 
erythemato-squamous  character,  generally  limited 
to  the  parts  of  the  body  exposed  to  the  sun's  rays. 
The  entire  face  is  often  covered  with  a  symmetri- 
cal distribution,  producing  the  typical  pellagra 
"mask,"  while  an  erythematous  circlet  around  the 
neck,  first  described  by  Casal,  is  very  character- 
istic. 

The  most  common  seat  for  the  lesions  are  the 
hacks  of  the  hands,  spreading  from  the  ulnar  to 
the  radial  sides,  but  sparing  the  nails  and  palms, 
and  having  a  distinct  line  of  demarcation  at  the 
cuff  line.  When  the  feet  are  similarly  exposed 
thev  are  usually  affected  in  the  same  way.     (  )c- 


casionally  the  genital  region  of  both  sexes  may 
be   affected. 

The  color  of  the  erythema  very  closely  re- 
sembles the  appearance  of  the  skin  after  ordinary 
sunburn,  at  first  being  a  dull  red,  and  later  of 
dark  brownish  hue.  The  eruption  may  be  dry  or 
moist  in  character,  and  in  the  milder  forms  may 
desquamate  in  a  few  weeks  in  the  form  of  fine 
scales. 

It  is  common  for  the  skin  to  become  infiltrated, 
thickened  and  swollen,  with  burning,  itching- 
sensations,  which  may  later  result  in  anesthesia. 
The  superficial  or  deeper  layers  of  the  skin  may 
be  the  seat  of  the  inflammation.  After  a  short 
while  the  epidermis  exfoliates,  leaving  the  under- 
lying surfaces  red  and  frequently  fissured,  greatly 
resembling  a  first  degree  burn. 

Pigmentation  takes  place  with  each  and  suc- 
ceeding attacks,  and  with  the  deep  infiltration 
leaves  the  organs  covered  with  a  corded,  irreg- 
ularly roughened  epidermis,  which  has  given 
the  disease  its  distinctive  title  of  "rough  skin." 
With  the  appearance  of  winter  the  cutaneous 
eruptions  usually  show  improvement,  only  to  have 
a  recrudescence  in  the  following  spring. 

After  repeated  attacks  the  skin  becomes 
wrinkled,  thickened  and  lax,  and  takes  on  a  senile 
appearance,  presenting  a  bluish  red  or  dark  brown 
color,  with  a  tendency  to  exfoliate  in  flakes  (Stel- 
wagon). 

The  inflammation  affects  the  mucous  mem- 
branes as  well,  giving  the  cardinal  red  color  to 
the  buccal  cavity,  with  similar  changes  in  the 
rectum. 

The  nervous  manifestations  of  pellagra,  which 
at  first  were  betrayed  by  headache,  vertigo, 
tremor  and  lassitude  in  the  early  stages  of  the 
disease,  become  progressively  worse,  often  re- 
sulting in  profound  mental  depression,  occasional- 
ly in  a  settled  melancholia,  which  may  be  inter- 
rupted by  periods  of  illusions  and  hallucinations, 
and  often  followed  by  stupor.  These  symptoms 
may  continue  until  the  patient  is  profoundly  pros- 
trated, with  resulting  death  from  emaciation,  or 
the  course  may  be  more  chronic,  terminating  in 
true  pellagrous  insanity. 

However,  insanity  is  not  as  frequent  a  com- 
plication as  is  generally  considered,  for  according 
to  the  Dunning  Report  of  Pellagra  in  Italy  only 
10  per  cent,  of  the  patients  of  that  country  become 
insane. 

Prognosis. — The   prognosis   of   pellagra    is   at 


THE    HOSPITAL    BULLETIN 


49 


best  very  grave,  although  in  countries  where  the 
disease  is  endemic,  and  in  mild  attacks,  the  out- 
look  is  fairly  favorable.  In  the  severe  cases  the 
average  duration  of  cases  is  five  years,  but  it 
may  continue  for  10  or   15  years. 

Most  of  the  cases  in  the  Smith  arc  of  the  acute 
variety,  generally  proving  fatal  within  a  shorter 
duratii  m. 

Treatment. — As  our  knowledge  in  regard  to  the 
etiology  of  the  disease  is  indefinite,  we  cannot 
exercise  proper  prophylactic  precautions,  but  we 
can  profit  by  the  example  given  us  by  the  Italian 
Government,  where  they  have  shown  that 
prophylactic  measures  cat)  reduce  the  prevalence 
wonderfully.  They  have  accomplished  their 
brilliant  results  by  elevating  the  hygienic  en- 
vironment of  the  poorer  classes  and  excluding 
damaged  maize  from  the  dietary  of  their 
peasantry.  Laws  have  been  enacted  for  the  in- 
spection   and    condemnation    of    suspected    f 1 

products,  and  compelling  the  authorities  to  re- 
port all  pellagrous  patients.  Commissions  have 
been  formulated  to  further  study  the  disease,  in- 
stitutions have  been  founded  for  the  care  of  the 
sick,  and  modern  "dietary  kitchens"  have  been 
established  in  the  poverty-stricken  districts,  with 
the  result  of  an  enormous  decrease  in  the  num- 
ber of  cases  in  that  country. 

Whether  damaged  maize  is  or  is  not  responsible 
for  the  disease  in  this  country,  scientific  men  have 
assigned  enough  value  to  its  relation  to  pellagra 
for  the  National  Pellagra  Conference,  held  in 
Columbia  1  1909),  to  declare:  "That  while  corn 
is  in  no  way  connected  with  pellagra,  evidences 
of  the  relation  between  the  use  of  spoiled  corn 
and  the  prevalence  of  pellagra  seem  so  apparent 
that  we  advise  the  continued  and  systematic  studv 
of  the  subject,  and  in  the  meantime  we  commend 
to  corn  growers  the  great  importance  of  fully 
maturing  corn  on  the  stalk  before  cutting  the 
same." 

The  medicinal  treatment  of  the  disease  is  dis- 
appointing. Xo  specific  remedies  have  been 
found.  The  hope  of  improvement  lies  in  placing 
the  patient  under  good  hygienic  surroundings  and 
improving  the  general  health  by  good  food  and 
such  tonics  as  are  indicated.  Arsenic,  in  the  form 
of  Fowler's  solution,  and  the  iron  preparations 
have  been  principally  used,  with  good  results  at 
times.  Atoxyl,  quinine  and  strychnine  have  been 
recommended. 

Cole   and   Wintrop   have   reported    success   by 


transfusing  blood  in  a  few  individuals.  Salvarsan 
has  been  tried  recently,  with  evident  improvement 
in  the  symptoms  of  the  few  cases  reported. 


A  CASE  OF  CEREBRAL  LUETIC  ENDAR- 
TERITIS WITH  A  TEMPORARY  OC- 
CLUSION OF  A  LOWER  ANTERIOR 
BRANCH  1  IF  THE  MIDDLE  (  ERE- 
BRAL  ARTERY,  CAUSING  A  TEMPO- 
RARY ANEMIA  1  IF  BR<  ICA'S  O  >NV<  >- 
LUTK  IN. 


By    MlLFORD    HlNNANT   and    HENDERSON    IkwI.V, 
Senior  Medical  Students. 


This  case,  which  was  treated  at  the  University 
of  Maryland  Hospital,  is  a  typical  case  with  many 
of  the  characteristic  symptoms. 

Name—W.  T.  C. 

Address — 

Occupation — Foreman  on  Railroad. 

Age — Thirty-eight  years. 

Sex — Male. 

Race — White. 

Social  Condition — Single. 

Chief  Complaint — Disturbance  of  speech.  In 
the  words  of  patient  lie  has  "trouble  in  speaking 
and  in  using  my  right  hand  properly." 

Family  History — Mental  troubles  negative.  Pa- 
tient's mother  is  nervous  and  excitable  at  times: 
negative  to  drug  habits:  constitutional  inherit- 
ances, so  far  as  tuberculosis,  syphilis,  nephritis, 
cardiac  diseases  and  malignancy,  is  negative. 

Previous  Medical  History — During  childhood 
he  had  nothing  except  whooping  cough.  His 
adolescent  stage  was  uneventful  as  to  any  medi- 
cal conditions.  Since  reaching  the  adult  stage 
the  patient  has  been  very  strong  and  healthy,  ex- 
cept for  an  occasional  attack  of  indigestion,  for 
which  he  was  treated  by  a  physician.  For  the 
past  three  months  be  has  been  suffering  with 
headache  and  dizzv  spells,  for  which  he  was  also 
treated:  the  nature  of  this  treatment  could  not  be 
obtained. 

Present  Illness — The  patient's  trouble  began 
by  having  a  constant  headache,  numbness  at 
times  (which  was  almost  constant)  of  the  right 
arm.  forearm  and  fingers,  and  peculiar  sensa- 
tions in  the  right  side  of  the  face.  1  lis  vision 
was  only    slightly   disturbed. 

On  July  <<  the  patient  was  advised  to  go  for 
a  little  outing  to  see  if  the  fresh  air  would  prove 


?o 


THE   HOSPITAL   BULLETIN 


beneficial.  The  patient  went  to  Curtis  Bay.  and 
after  being  there  for  about  two  hours,  he  began 
to  feel  as  if  he  were  going  to  faint.  He  had  no 
pain,  but  realized  that  he  was  getting  weak  and 
felt  very  queer.  He  then  went  to  a  friend's 
house  and  very  soon  afterwards  he  could  not  talk, 
and  tried  to  write,  but  all  he  could  do  was  to 
make  a  few  signs.  He  was  perfectly  conscious 
of  his  surroundings  but  could  not  express  him- 
self. At  the  same  time  he  lost  the  entire  use  of 
his  right  arm  and  hand. 

Physical  Examination — Thorax,  well  formed, 
lung  expansion  equal  on  both  sides ;  palpation 
and  percussion  negative;  auscultation,  normal  re- 
spiratory sounds.  Heart  inspection,  P.  M.  I.  in 
fifth  interspace  in  mid-nipple  line ;  palpation  con- 
firms inspection ;  percussion,  area  of  cardiac  dull- 
ness normal :  auscultation,  over  the  apex  there  is 
a  soft  systolic  flow  :  over  the  base  there  is  a  soft 
murmur;  no  appreciable  accentuation  of  the 
second  sound. 

Abdomen  soft ;  spleen  not  palpable ;  liver  dull- 
ness normal ;  no  masses  to  be  felt,  no  hernia, 
no  tenderness.  Upper  and  lower  extremities  are 
very  well  formed  and  show  no  scars  nor  in- 
jury. 

SPECIAL    EXAMINATII  >N. 

Head,  fair  amount  of  brown  hair;  skin  clear. 

Ears,  well-formed  and  in  normal  position,  but 
a  partial  deafness  exists  on  both  sides. 

Exes,  react  to  light  and  accommodation;  area 
of  vision  diminished ;  slight  retraction  of  both 
upper  lids. 

Neck,  normal. 

Kidneys,  normal. 

Bladder,  normal. 

Blood,  leucocytes  14,605 ;  hemaglobin  95, 
blood  pressure  95,  'YVasserman  reaction,  positive. 

Urine,  reddish-amber  color,  a  few  epithelial 
cells,  leucocytes  and  granular  casts.  Albumen  and 
sugar  negative;  sp.  gr.  1030.  reaction  acid. 

Stomach  contents,  normal. 

Spinal  Fluid — Leucocyte  count  30  to  a  field, 
stained  smear  shows  increase  in  leucocytes  of 
small  variety. 

Fundi  of  the  Eyes — Normal. 

.V  put  11  in — Negative. 

Nervous  Examination — Intellect  only  fair; 
memor)  is  poor;  speech  articulation  is  disturbed; 
speaks  indistinctly:  speech  is  thick.     He  recog- 


nizes objects  but  it  is  difficult  to  articulate  their 
names.     Gait,  normal ;  moves  his  limbs  well. 

Motor  Examination — The  right  arm  is  weaker 
than  the  left.  The  grip  of  the  right  hand  is 
weaker  than  that  of  the  left.  The  motor  power 
of  the  lower  extremities  is  about  equal.  There  is 
no  tremor  or  spasm  of  any  of  the  muscles  of  the 
body.  The  muscles  of  the  right  side  of  the  face 
are  weak.  This  is  particularly  marked  in  the  buc- 
cinator. 

Co-ordination  of  upper  and  lower  extremities 
is  not  good,  showing  more  disturbance  of  the 
right  side  than  of  the  left. 

Romberg's  sign,  positive. 

Babinsky's  sign,  present  in  right  foot.  Nega- 
tive in  the  left. 

Kernig's  sign,  negative.  Superficial  reflexes 
increased. 

Deep  reflexes,  knee  reflexes  increased  on  both 
sides.  Tendo-Achilles  increased  on  right  side, 
normal  on  left.  Periosto-radial  and  triceps  more 
marked  on  left  than  on  right  side :  no  cervical 
rigidity ;  no  spinal  tenderness. 

Sensations,  tactile  good,  pain  good,  tempera- 
ture good,  muscular  sensations  fair. 

Treatment. — The  patient  was  admitted  to  the 
hospital  at  8  P.  M.  on  July  6;  was  given  a  purge 
and  then  strychnine  gr.  1/60,  morphia,  gr.  1/10. 
He  was  given  strychnine  gr.  1/30  t.  i.  d.  until  July 
15:  at  this  time  he  was  given  nitro-glycerine  gr. 
1/100  and  this  was  kept  up  until  August  12. 

(  In  August  12  patient  -was  discharged.  His 
articulation  was  good :  his  face  and  hand  were 
useful :  he  had  a  good  color  and  the  troubled  face 
had  given  way  to  a  pleasant  expression  and  he 
was  in  good  condition  generally. 


Dr.  William  \Y.  Braithwaite.  class  of  1909, 
sailed  for  Panama  on  the  23d.  Dr.  Braithwaite 
has  been  appointed  to  the  Isthmian  Canal  Com- 
mission Hospital  (550  beds)  at  Cristobal.  He  is 
a  native  of  North  Dakota,  and  lived  for  some  time 
in  Southern  Maryland  before  coming  to  Balti- 
more and  entering  the  University. 


Dr.  Marshall  Langdon  Price,  class  of  1903.  is 
a  member  of  the  recently-appointed  Sanitation 
Commission,  which  will  confer  with  a  similar 
commission  of  the  District  of  Columbia  with  ref- 
erence to  the  disposal  of  sewage  in  the  District 
anil  the  sections  of  Maryland  contiguous  to  the 
District. 


THE   HOSPITAL   BULLETIN 


5i 


TECHNICAL  AND  SCIENTIFIC  QUALIFI- 

CATK  »NS  OF  A  TEACHER  OF 

PHYSIOLOGY. 


By  John  C.  J  [emmeter. 

Member  of  the  Deutsche  Physiologische  Gesell- 

schaft;  Professor  of  Physiology,   University 

of  Maryland. 


<  >ur  country  was  the  only  one  in  which  it  was 
legal  tn  organize  medical  schools  by  an  associa- 
tion of  private  individuals  during  the  latter  half 
of  the  last  century.  The  result  was  an  exuber- 
ance of  so-called  schools  that  were  in  reality  stock 
companies  organized  by  private  practitioners  with 
a  view  to  benefiting  either  directly  from  the  tui- 
tion fees  or  indirectly  from  consultation  work 
brought  by  students  and  graduates. 

As  medicine  became  more  and  more  an  exact 
science  by  the  growth  of  anatomy,  physiology, 
chemistry,  pathology,  bacteriology,  it  became  evi- 
dent to  even  the  egotistical  managers  of  what 
might  without  exaggeration  be  called  "Commer- 
cial Medical  Schools"  that  certain  subjects  were 
beyond  the  ability  of  the  "physicians"  as  then 
educated,  and  they  were  compelled  nolens  volens 
to  elect  specialists  in  chemistry — men  who  had 
obtained  the  degree  of  Doctor  of  Philosophy  in 
one  of  our  foremost  endowed  universities  by  .1 
thorough  and  intensive  study  and  research  work 
in  chemistry.  This  was  a  step  forward,  but 
physiology  was  still  taught  largely  in  a  dilettan- 
tish, amateurish  way  by  practitioners  who  had  no 
special,  or  at  best  only  a  very  superficial,  train- 
ing in  physiology. 

Chemistry  is  not  a  science  that  is  based  on  many 
adjuvant  or  collateral  branches  of  human  knowl- 
edge— a  preliminary  A.B.  in  a  good  college  ap- 
parently still  equips  a  man  to  enter  on  this  special 
study.  But  physiology  demands  of  its  devotees 
a  thorough  training  in  numerous  other  independ- 
ent sciences.  Chemistry  is  a  structure  of  human 
knowledge  self-sufficient  in  itself;  perhaps  physics 
may  be  considered  as  an  adjuvant  science  indis- 
pensable to  an  understanding  of  chemistry. 
Physiology — the  science  of  the  regular  processes 
that  go  on  in  living  things — requires  a  preliminary 
training  in  chemistry,  physics,  botany,  general 
biology  ami  anatomy. 

To  be  a  physiologist  a  teacher  must  make  him- 
self an  expert  in  hundreds  of  little  and  major 
operations  where  the  instrumental  technique — the 


asepsis  and  the  knowledge  of  anatomy — indicate 
whether  a  teacher  is  a  dilettante  or  a  trained  ex- 
perienced physiologist. 

In  addition,  the  science  of  life  has  in  the  last 
20  or  25  years  been  so  enormously  extended, 
such  a  wealth  of  literature  has  accumulated  and  is 
constantly  being  added  to,  that  unless  a  teacher 
speaks,  reads  and  writes  at  least  three  modern 
languages  it  is  almost  impossible  to  keep  abreast 
of  the  progress  of  his  own  time  in  the  advances 
that  are  made. 

Personally,  I  have  found  that  my  own  course 
in  physiology  requires  readjusting  and  remodel- 
ing every  year,  so  that  my  system  of  physiologic 
discipline  has  not  been  alike  in  any  two  years,  and 
it  would  be  fatal  to  inculcate  into  the  mind  of  any 
class  of  students  that  such  a  course  could  be  so 
given  that  all  lectures,  demonstrations  and  confer- 
ences would  be  exactly  alike  in  two  consecutive 
years,  for  to  them  this  would  soon  mean  that  the 
science  had  stood  still,  and  that  means  stagnation. 
A  teacher  must  never  cease  occupying  himself 
with  one  research  or  another  if  he  desires  to  be  a 
true  university  teacher,  for  only  as  a  research 
worker  can  he  gain  a  deep  insight  into  the  whole 
biochemic  and  biophysic  driving  mechanism  of 
the  living  substance. 

Strange  as  it  may  seem,  the  absorbing  interest 
and  training  in  clinical  medicine  exceedingly 
rarely  fits  a  man  for  the  teaching  of  physiology, 
whereas  a  training  of  exhaustive  thoroughness 
in  phvsiology  is  the  best  preparation  imaginable 
for  the  clinician.  The  reason  for  this  divergent 
mutual  utility  between  clinical  medicine  and  physi- 
ology is  to  be  sought  in  the  fact  that  only  exact 
and  objective  sciences  can  be  fundamental  to 
other  sciences.  And  medicine  is  not  an  exact 
science.  But  physiology  is  becoming  one  of  the 
most  exact  and  objective  sciences  that  the  human 
mind  has  formulated  ;  it  postulates  absolute  eman- 
cipation from  the  intuitive  and  imaginative  func- 
tions of  the  mind  and  unconditional  submission 
to  the  hard  yoke  of  objective  investigation.  A 
kind  of  mind  that  is  only  exceptionally  and  exceed- 
ingly rarely  developed  by  a  medical  training. 

The  period  during  which  the  medical  faculty 
could  appoint  practitioners  of  medicine  to  fill  the 
positions  of  teachers  in  physiology  has  passed  20 
years  ago.  It  is  just  as  impossible  for  a  practi- 
tioner of  medicine  to  teach  physiology  as  it  is  for 
him  to  satisfactorily  fill  the  chair  of  chemistry. 
A    highly-specialized    physiologic    technique   has 


THE    HOSPITAL    BULLETIN 


become  indispensable,  in  addition  to  tbe  thorough 
grounding  in  the  facts,  doctrines  and  hypotheses 
of  the  science  itself,  and  to  have  physiology  taught 
by  one  who  by  habit  is  accustomed  to  thinking 
only  clinically  gives  physiologic  science  a  twist  and 
warp  in  the  hands  of  such  a  man  which  distorts 
its  aim  and  makes  true  understanding  of  the  nor- 
mal processes  of  life  practically  impossible.  From 
()/</  Maryland  for  May,  1907,  p.  66,  we  quote  the 
following:  "In  order  to  have  physiology  taught 
in  the  highest  and  most  skilful  manner.  Dr.  and 
Airs.  J.  C.  Hemmeter  have  made  an  agreement 
with  the  trustees  of  the  Endowment  Fund  of  the 
University  of  Maryland,  which  was  made  in  1907. 
The  following  extract  is  taken  from  this  agree- 
ment as  it  apeared  in  Old  Maryland  for  May, 
1907,  p.  66: 

"In  beginning  an  Endowment  for  a  Chair  of 
Physiology  in  the  University  of  Maryland,  Prof, 
and  Mrs.  John  C.  Hemmeter  'recommend  and  re- 
quest' that  the  Board  of  Trustees  observe  the  fol- 
lowing conditions:  'The  first  installment  of 
$1500,  together  with  future  yearly  contributions 
,  and  such  legacies  as  will  be  bequeathed  for  this 
same  purpose,  are  to  be  kept  at  interest  until  the 
principal  has  accumulated  sufficiently  to  yield  a 
salary  of  at  least  $3000  annually  to  the  professor 
holding  the  chair  at  the  time  when  this  amount 
shall  have  accumulated. 

"  'If  at  that  period  a  larger  salary  is  required 
for  a  professor,  the  $3000  annually  accumulating 
from  this  fund  may  nevertheless  be  utilized  for 
this  purpose,  provided  the  administrative  body  of 
the  University  of  Maryland  at  that  time  agrees  to 
supply  the  difference' needed  to  complete  the 
amount  required. 

'  'It  is  urgently  desired  that  the  benefits  accru- 
ing from  this  fund  shall  not  be  available  or 
granted  to  any  teacher  who  is  not  a  trained 
physiologist.  By  that  we  mean  that  he  must  have 
made  a  special  study  of  physiology  for  at  least 
four  years  in  the  laboratories  of  physiology  of 
one  or  other  of  our  larger  universities,  such  as 
Harvard,  Yale  or  Columbia  of  the  City  of  New 
York. 

''We  distinctly  desire  to  have  it  understood 
that  the  benefits  from  this  fund  are  not  to  be 
granted  to  teachers  who  simply  have  a  degree  in 
medicine  only,  and  have  no  special  training  in 
physiology.  "What  we  understand  by  special 
training  is  defined  in  the  preceding.  Tbe  object 
>'  this  is  to  make  the  leaching  of  physiology  more 


and  more  objective,  and  not  to  depend  upon  lec- 
tures exclusively,  but  more  upon  laboratory  work. 

"  'In  awarding  the  professorship  it  is  our  desire 
that  candidates  who  are  born  and  educated  in  this 
State,  and  particularly  alumni  of  this  University, 
shall  be  given  the  preference  ;  but  if  none  such  can 
be  found  who  have  gone  through  special  training 
either  in  Europe  or  in  the  large  universities  of 
this  country,  candidates  from  any  State  or  nation- 
ality may  be  selected.' 

"The  founders  of  this  fund  do  not  state  the 
amount  it  is  their  intention  to  give  to  it.  but  de- 
clare that  provision  will  be  made  in  their  wills 
for  its  increase.  The  fund  now  amounts  to  $5400." 
The  founders  of  this  fund  should  insist  upon  the 
conditions  of  high  and  exclusive  scholarship,  tech- 
nical training  and  ability,  together  with  a  broad 
experience.  For  broad  experience,  conservative 
yet  penetrating  critical  judgment,  a  fanatical  en- 
thusiasm for  truth  and  exactness,  together  with  a 
warm,  sane  heart,  are  qualifications  sine  qua  non 
in  physiologic  discipline.  The  thought  may  oc- 
cur why  medical  men  are  to  be  excluded  from  the 
chair  of  physiology,  since  the  writer  is  himself  a 
clinician.  It  is  because  of  this  very  fact  that  he 
is  best  able  to  realize  his  own  shortcomings  as  a 
teacher  of  physiology,  and  that  as  far  as  the  Uni- 
\  ersity  of  Maryland  is  -concerned,  the  list  of 
clinician  physiologists  will  end  when  his  activity 
in  that  chair  ends.  His  successor  will  be  a  trained 
physiologist  pure  and  simple,  and  the  days  of  the 
last  Medical  Mohican  in  that  science  are  come 
when  he  terminates  his  connection  with  this 
University. 


Governor  Goldsborough  has  appointed  the  fol- 
lowing alumni  as  coroners : 

Northern  District — Dr.  Henry  C.  Algire,  class 
of  1895,  of  3640  Roland  avenue.  Dr.  Algire  is 
37  years  of  age  and  a  native  of  Baltimore.  He 
succeeds  Dr.  G.  Milton  Linthicum. 

At  Large — Dr.  Henry  C.  Hyde,  class  of  1899, 
of  1024  E.  North  avenue.  Dr.  Hyde  is  a  native 
of  Baltimore  and  is  43  years  of  age.  He  is  a  lec- 
turer on  pathology  and  bacteriology  in  the  Uni- 
versitv  of  Maryland. 


Dr.  J.  Burr  Piggott,  class  of  11)07.  is  now  lo- 
cated at  the  Thomas,  1400  M  street  N.  W.,  Wash- 
ington, D.  C. 


THE    HOSPITAL   BULLETIN 


53 


THE   HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

PUBLISHED    BY 

THE   HOSPITAL   BULLETIN    COMPANY 

608  Professional  Building 

Baltimore,  Md. 


Subscription  price,     .     .     .     $1.00  per  annum  in  advance 

Reprints  furnished  at  cost.     Advertising  rates 
submitted  upon  request 


Nathan    Winslow,  M.D.,  Editor 


Baltimore,  May  15,  1912. 


"WE  HAVE  PIPED  UNTO  YOU,  AND  YE 
HAVE  NOT  DANCED." 


The  above  quotation  about  expresses  the  situa- 
tion in  regard  to  the  pathological  endowment 
fund.  We  have  called  unto  you,  and  you  have 
not  responded.  We  have  piped  in  dulcet  tones, 
and  you  have  not  jigged.  Ross  R.  YVinans,  a 
recluse  and  misanthrope,  died  recently  in  this 
city.  I  lis  estate  is  supposed  to  he  worth  about 
$4,000,000,  and  was  left  to  relatives  and  friends. 
Not  one  cent  was  left  to  charitable  or  philan- 
thropic institutions.  A. half  million  dollars  was 
left  to  a  fine  young  woman  at  Newport,  R.  I., 
who  had  been  attentive  to  him  when  he  was 
ailing.  We  congratulate  her  on  her  good  for- 
tune. A  man  has  the  right  to  dispose  of  his 
property  in  accordance  with  his  own  wishes,  but 
one  would  think  he  would  rest  more  comfortably 
if  he  had  left  something  to  the  unfortunate  and 
suffering.  Dr.  Pearsons  of  Chicago  died  recently 
at  a  very  advanced  age  and  left  scarcely  enough 
to  give  himself  a  decent  buriel.  During  his  life- 
time he  gave  away  all  his  property  to  small  and 
needy  colleges  :  his  benefactions  amounting  to  sev- 
eral million  dollars.  He  certainly  chose  the  bet- 
ter part.  Medical  schools  must  have  money  mure 
than  can  be  obtained  from  students'  fees.  What 
a  Godsend  $500,000  would  be  to  us !  However, 
we  are  not  proud.  If  you  can't  give  that  amount, 
we  would  be  pleased  to  have  contributions  of  $25 


ach  from  our  Alumni.     Don't  wait  until  you  are 
lead,  give  now. 

CONTRIBUTION    BY   CLASSES. 

848 $50   OO 

868 10  00 

<s7i 35  00 

~!<J2 JO    OO 

*7S 430  00 

•s74 5  00 

*75 5  oo 

876 115  00 

877 10  00 

880 5  OO 

881 250  00 

882 310  00 

883 35  00 

885 -?35  00 

886 100  00 

888 50  00 

889 100  00 

890 175    OD 

892 I  50   OO 

893 15  03 

894 135  00 

895 155  00 

896 52  00 

897 80  00 

898 105  OO 

899 25  00 

900 215  00 

901 175  00 

902 305  00 

903 300  00 

904 145  00 

905 200  00 

906 130  00 

907 1 10   00 

909 5  00 

ijio 50  00 

t)  1 1   Terra   Mariae 3  5° 

912  Club    Latino-Americano 25  00 


Total  subscription  to  May   I,  1912.  .$9895  50 

srnscKiPTioxs  in  april. 
Dr.  Joseph  T.  Smith,  1872  (  second  con- 
tribution)   $5  00 

Dr.  Walter  S.  Phillips,  1897 10  oo 

Dr.  John  A.  Tompkins,  Jr.,  1898 25  00 

Dr.  Arthur  J.  Edwards.  1899 25  00 

Dr.  C.  B.  Williams,  W.  Va 25  00 


Additions  for  the  month $90  00 


54 


THE    HOSPITAL    BULLETIN 


ABSTRACT 

In  a  very  instructive  article  on  "Cartilaginous 
Tumors  of  the  Larynx"  {Annals  of  Otology, 
tihinology  and  Laryngology,  December,  1911), 
Dr.  James  J.  Carroll,  class  of  1893,  of  Baltimore, 
after  reviewing-  the  literature  on  the  subject,  re- 
ports the  following  case,  which  came  under  his 
observation  in  October,  1907,  and  which  has  not 
been  reported  previously : 

L.  T.  T.,  white,  single.  34  years  old,  a  railroad 
engineer,  had  always  enjoyed  good  health  until 
lie  contracted  lues  in  1904  and  had  both  primary 
and  secondary  lesions.  Patient  took  antisyphilitic 
treatment  for  a  year,  after  which  he  stopped  the 
medicine  because  he  was  free  from  symptoms. 
Pour  months  before  coming  under  observation 
patient  began  to  get  hoarse,  the  hoarseness  grad- 
ually giving  way  to  aphonia.  About  a  month  after 
the  hoarseness  came  on  he  began  to  have  some 
difficult}'  in  breathing,  and  two  months  later  he 
noticed  an  enlargement  of  his  throat  in  the  region 
of  the  larynx.  He  came  to  St.  Joseph's  Hospital. 
October  26,  1907,  to  find  out  the  cause  of  his 
hoarseness.  Examination  showed  the  patient  to 
be  in  excellent  physical  condition,  all  organs  nor- 
mal except  the  larynx.  He  was  aphonic  and  had 
some  difficulty  in  breathing,  which  was  aggra- 
vated by  the  recumbent  position  and  by  walking. 
He  had  a  short,  quick,  metallic  cough,  which  was 
made  worse  by  lying  down.  There  was  no  diffi- 
culty nor  pain  upon  swallowing.  Exteriorly  there 
was  a  swelling  over  the  thyroid  cartilage  on  the 
left  side.  Xo  glandular  enlargements  were  felt 
in  the  neck.  Laryngoscope  showed  a  large  rose 
colored  subglottic  tumor.  Its  surface  was  even, 
smooth,  clean  and  free  from  ulceration.  It  lay 
just  under  the  vocal  cords,  attached  loosely  to  the 
under  surface  of  the  posterior  half  of  the  right 
cord  and  firmly  connected  with  the  posterior  two- 
thirds  of  the  left  cord.  The  apex  was  free,  round- 
ed, and  came  within  5  or  6  mm.  of  touching  the 
anterior  wall  below  the  commissure.  The  base 
was  attached  to  the  posterior  wall  and  to  a  slight 
degree  to  the  lateral  walls.  The  right  cord  was 
congested  and  moved  pretty  freely,  but  not  en- 
tirely to  the  middle  line.  The  anterior  third  of 
the  left  cord  was  free  from  congestion,  but  the 
cord  itself  was  fixed  to  the  side  of  the  larynx. 
The  right  arytenoid  moved  freely  on  attempt  at 
phonation,  but  the  left  had  only  a  slight  motion, 
of  a  rotary  character,  with  no  approximation  to 


the  median  line.  There  was  a  little  thin  mucus 
about  the  laryngeal  cavity,  but  no  muco-purulent 
secretion.  A  few  drops  of  cocain  and  adrenalin, 
injected  into  the  larynx,  made  no  change  in  size 
or  contour  of  the  tumor.  A  radiograph  taken 
by  Dr.  H.  Ashbury  showed  very  clearly  a  more 
or  less  circular  shadow,  the  upper  boundary  of 
which  was  about  on  a  level  with  the  middle  hori- 
zontal plane  of  the  thyroid  cartilage,  and  the  lower 
boundary  fell  a  little  below  the  ring  of  the  cricoid. 
The  anterior  border  was  free,  while  posteriorly 
the  shadow  of  the  tumor  was  continuous  with 
the  shadow  of  the  cricoid  plate. 

As  the  patient  had  had  syphilis,  he  was  put  on 
antiluetic  treatment  for  a  month,  although  the 
larynx  did  not  present  a  picture  which  in  any  way 
resembled  the  usual  syphilitic  lesions  of  the 
larynx.  The  growth  was  also  not  malignant  in 
appearance.  Of  the  benign  tumors  it  suggested 
most  strongly  a  chondroma  or  an  internal  struma. 
A  positive  diagnosis  between  these  two  was  not 
ventured  without  a  histologic  examination.  The 
patient  was  exhibited  before  the  Rhino-Laryngo- 
logical  Section  of  the  Baltimore  City  Medical 
Society.  November  29,  1907. 

The  large  size  of  the  tumor  and  its  position 
below  the  cords  precluded  the  possibility  of  remov- 
ing it  by  an  endolaryngeal  operation  ;  the  external 
operation  was  therefore  decided  upon.  A  prelimi- 
nary tracheotomy  through  the  third  ring  was 
done  on  December  11,  1907.  On  the  14th  laryngo 
fissure  was  performed  by  the  late  Dr.  I.  R.  Trim- 
ble, with  the  patient  under  chloroform.  A  vertical 
incision  was  made  in  the  skin  in  the  median  line 
from  the  hyoid  bone  to  the  second  ring  of  the 
trachea  where  it  joined  the  tracheotomy  wound. 
After  the  thyroid  cartilage,  the  cricothyroid  mem- 
brane and  the  cricoid  cartilage  were  well  exposed, 
a  vertical  section  was  made  through  the  last  two, 
exposing  the  lower  part  of  the  tumor.  The 
growth  filled  almost  the  entire  subglottic  space, 
leaving  only  enough  room  between  the  apex  of 
the  tumor  and  the  anterior  commissure  to  pass  a 
grooved  director.  The  lower  surface  of  the 
growth  was  smooth,  pale  red.  slightly  irregular 
and  free  from  ulceration.  To  expose  the  mass 
satisfactorily  the  section  had  to  be  extended  up- 
wards through  the  entire  thyroid  cartilage,  which 
was  exceedingly  hard  to  cut.  With  the  sides  of 
the  thyroid  cartilage  pulled  apart,  ample  room  was 
obtained  for  manipulation.  Laryngeal  reflexes 
were  abolished  by  cocain  and  the  bleeding  checked 


THE    HOSPITAL   BULLETIN 


55 


b)  adrenalin.  Tumor  was  quite  firm  to  the  touch. 
Its  free  bonier  faced  anteriorly  and  to  the  right, 
the  attachment  being  posteriorly  and  along  the 

left  wall  of  the  larynx.  The  enveloping  mem- 
brane, largely  mucous  membrane,  was  opened  at 
the  apex.  A  grayish-white  granular  material 
OOzed  through  this  opening,  not  unlike  boiled 
grits  in  appearance  and  consistency.  The  bulk  of 
the  tumor  was  removed  with  curette  and  most  of 
the  enveloping  membrane  with  scalpel.  After 
the  u>e  of  the  curette  the  plate  of  the  cricoid  was 
seen  denuded  of  mucous  membrane  and  peri- 
chi  mdrium.  The  exact  site  of  the  growth  was  the 
left  half  of  the  cricoid  plate,  the  posterior  half  of 
the  cricothyroid  membrane  and  the  adjacent  thy- 
roid cartilage.  The  origin  was  evidently  from  the 
cricoid,  the  thyroid  being  affected  by  extension. 
The  tumor  was  as  large  as  a  medium-sized  Eng- 
lish walnut,  measuring  about  an  inch  in  both  ver- 
tical and  horizontal  diameters.  Its  upper  surface 
under  the  cords  was  more  flattened  than  the  lower 
facing  the  trachea.  In  closing  the  wound  the 
sides  of  the  thyroid  cartilage  were  brought  to- 
gether with  silver  wire.  The  cricoid  ring  was  not 
sutured  and  the  tracheotomy  tube  was  brought 
up  from  the  tracheotomy  wound  and  inserted  here, 
the  original  wound  in  the  trachea  being  allowed 
to  close.  The  tube  caused  a  good  deal  of  pain 
anil  cough,  and  was  removed  on  the  second  day 
after  the  operation.  Wound  was  firmly  healed 
en  the  twentieth  day.  Patient  recovered  with  a 
much-improved  voice,  good  easy  breathing  and 
no  cough.  Perfect  vocal  function  could  not  be 
expected  on  account  of  the  unavoidable  destruc- 
tion of  a  good  part  of  the  left  cord.  At  this  writ- 
ing there  is  no  evidence  of  recurrence.  A  histo- 
logic  examination  of  the  tumor  was  made  by  Dr. 
E.  H.  Hayward,  whose  report  is  as  follows : 

"The  specimen  consists  of  several  small  frag- 
ments of  tissue,  pink  in  color  and  of  the  consis- 
tency of  muscle.  There  is  no  evidence  of  any  old 
calcareous  deposits  on  cutting  the  prepared  speci- 
men. Histologically  there  is  seen  a  groundwork 
of  material  similar  in  structure  to  hyaline  carti- 
lage. Scattered  throughout  this  are  irregular 
nests  of  cartilage  cells,  many  spindle-shaped  fi- 
brous tissue  cells,  areas  of  myxomatous  degenera-  ' 
tion  with  fairly  numerous  stellate  cells,  and  some 
small  calcareous  deposits.  The  most  numerous 
and  characteristic  elements  are  the  cartilage  cells. 
They  are  rather  atypical  and  show  no  regularity 
in  arrangement.     They  are  collected  in  scattered 


masses,  separated  by  immature  fibrous  tissue  and 

by  elements  of  degeneration.     Manv  of  the  cells 
are  without  capsules." 

He  concludes  his  article  as  follows: 
i.  There  should  be  uniformity  of  nomencla- 
ture. The  term  enchondroma  should  retain  the 
meaning  given  it  by  Virchow,  and  should  not  be 
applied  to  growths  of  the  larynx,  these  being 
either  chondroma,  ecchondroma,  ecchondrosis  or 
mixed  tumor. 

2.  Ecchondroses  of  the  larynx  should  be  re- 
garded as  overgrowths  of  cartilage,  not  real 
tumors. 

3.  Although  chondroma  has  been  known  to 
recur,  and  even  to  metastasize,  it  is  not  an  in- 
vasive neoplasm  in  the  broad  sense  of  the  term, 
and  should  be  looked  upon  rather  as  benign  than 
malignant. 

4.  Although  the  clinical  aspect  of  the  disease 
is  quite  definite,  the  etiology  is  still  much  in  doubt. 
In  1888  Bruns  said  "cartilaginous  tumors  of  the 
larynx  are  so  rare  that  the  study  of  every  case  is 
of  the  greatest  value  in  order  to  establish  the 
clinical  course  of  the  disease  and  to  furnish  data 
for  proper  therapeutic  measures."  The  clinical 
course  of  the  disease  has  been  pretty  clearly  de- 
termined by  the  various  cases  published  since 
Bruns'  article.  The  histologic  and  pathologic 
phase  of  the  subject  has  been  well  brought  out  by 
Alexander's  work.  The  etiologic  phase,  however, 
lags  behind  and  invites  further  wi  irk  and  careful 
investigation. 

512  Professional  Building. 


ITEMS 

Dr.  Robert  Tarke  Bay.  class  of  1905,  delivered 
an  illustrated  lecture  on  "Fractures"  before  the 
Howard  County  Medical  Society  at  Ellicott  City, 
March  19,  1912. 


The  following  committee  report  was  adopted 
at  the  meeting  of  the  Alumni  Advisory  Council: 

To  the  University  of  Maryland  Alumni  Advis- 
ory Council : 

Gentlemen — We  beg  to  submit  fur  your  con- 
sideration the  following  suggestions  to  be  offered 
the  Faculty  of  Physic. 

(1)  That  it  is  the  sense  of  this  body  that  every 
effort  be  made  and  no  sacrifice  be  considered  too 
great  to  comply  with  the  recent  requirements  of 
the  American    Association   of   Medical    Schools, 


56 


THE    HOSPITAL    BULLETIN 


calling-  for  the  establishment  of  four  full-time  pro- 
,  fessorships. 

(2)  That  the  inauguration  of  physical  thera- 
peutics as  a  separate  lectureship  is  a  timely  inno- 
vation in  the  line  of  progress. 

(3)  That  the  effort  to  establish  an  endowment 
fund  for  the  chair  of  pathology,  inaugurated  by 
Prof.  Randolph  Winslow,  is  worthy  of  highest 
commendation  and  merits  earnest  support. 

(  4 )  That  in  our  opinion,  no  student  should  be 
admitted  to  the  third  year  until  all  previous  con- 
ditions shall  have  been  met.  We  believe  the  per- 
centage of  failures  at  the  State  Board  Examina- 
tions will  thereby  be  materially  reduced. 
Respectfully  submitted. 

Signed:     Harry  Adler,  Chairman, 
G.  Lane  Taneyhill, 

JoSEfH  GlCHNER. 


Dr.  Arthur  M.  Shipley,  class  of  1902,  has  re- 
moved to  1827  Eutaw  place,  Baltimore,  Md. 


The  members  of  the  Adjunct  Faculty  of  the 
Medical  Department  of  the  University  of  Mary- 
land are : 

Doctors — 

J.  R.  Abercrombie,  S27  X.  Eutaw  street. 

J.  F.  Adams,  1316  X.  Charles  street. 

H.  A.  Adler,  1904  Madison  avenue. 

II.  E.  Ashbury,  1020  Cathedral  street. 

Daniel  Base,  Pharmaceutical  Department,  Uni- 
versity of  Maryland. 

Robert  I'.  Bay.  1701  Guilford  avenue. 

Hugh  Brent,  906  X.  Calvert  street. 

Albert  11.  Carroll.  906  X.  Calvert  street. 

Henry  M.  Chandlee,  742  \Y.  North  avenue. 

William  G.  Clopton,  2611  E.  Fayette  street. 

C.  C.  Conser,  11 13  X.  Fulton  avenue. 

J.  M.  Craighill,  1730  X.  Charles  street. 

M.  J.  Cromwell,  The  Latrobe.  Charles  and 
Read  streets. 

II.  C.  Davis,  114  W.  Franklin  street. 

S.  De  Marco,  1604  Linden  avenue. 

I 'age  Edmunds,  The  Wentworth,  Cathedral 
and  .Mulberry  streets. 

A.  L.  Fehsenfeld,  Garrison  and  Fairview  ave- 
nues. 

George  A.  Fleming,  1018  Madison  avenue. 

John  S.  Fulton,  2211  St.  Paul  street. 

E.  E.  ( iibbons,  1 102  W.  Lafayette  avenue. 

Joseph  E.  Gichner,  1516  Madison  avenue. 

Thomas  C.  <  iilchrist,  Professional  Building. 


R.  C.  Harley,  1309  W.  North  avenue. 

J.  F.  Hawkins,  1618  Light  street. 

George  Hemmeter,  800  Harlem  avenue. 

Jose  L.  Hirsh,  1819  Linden  avenue. 

Joseph  W.  Holland,  1624  Linden  avenue. 

John  Houff,  15  X.  Monroe  street. 

J.  Mason  Hundley,  1009  Cathedral  street. 

II.  C.  Hyde,  1024  E.  Xorth  avenue. 

J.  Knox  Insley,  2938  E.  Baltimore  street. 

John  G.  Jay,  817  X.  Charles  street. 

Richard  11.  Johnston,  807  N.  Charles  street. 

H.   \Y.  Junes.  Augusta  and  Frederick  avenues. 

Leo  Karlinsky,  11 14  Chesapeake  street. 

G.  S.  M.  Kieffer,  Morrell  Park. 

Frank  J.  Kirby.  no  E.  Xorth  avenue. 

E.  1 1.  Kloman,  1619  St.  Paul  street. 

F.  Levinson. 

G.  C.  Lochard,  163 1  W.  Lafayette  avenue. 

F.  S.  Lynn.  1619  St.  Paul  street. 
Harry  D.  McCarty,  O13  Park  avenue. 
Charles  W.  McElfrcsh,  1415  Linden  avenue. 
H.  J.  Maldeis,  437  E.  25th  street. 

Frank  Martin,  ioon  Cathedral  street. 

Mm.  I.  Messick,  1606  Madison  avenue. 

Roscoe  C.  Metzel,  1903  W.  Xorth  avenue. 

Robert  L.  Mitchell,  21 12  Maryland  avenue. 

J.  F.  O'Mara,  1042  Edmondson  avenue. 

Elisha  S.  Perkins,  The  Rochambeau. 

Oliver  Parker  Penning.  171 1  St.  Paul  street. 

William  Queen,  Arlington. 

J.  Dawson  Reeder.  639  X.  Fulton  avenue. 

Compton  Riely,  2025  X.  Charles  street. 

Harry  M.  Robinson,  20to  Wilkens  avenue. 

George  M.  Settle,  2435  Maryland  avenue. 

H.  L.  Sinskey,  1616  E.  Baltimore  street. 

C.  C.  Smink,  Lauraville.  Md. 

William   F.  Sowers.  2311    Edmondson  avenue. 

Irving  J.  Spear,  i8'0  Madison  avenue. 

St.  Clair  Spruill,  1002  Cathedral  street. 

J.  H.  Smith,  Jr.,  2205  St.  Paul  street. 

Joseph  T.  Smith,  The  Cecil. 

William  H.  Smith,  3429  Chestnut  avenue. 

II.  W.  Stoner,  2229  E.  Federal  street. 

Wilbur  Stubbs,  647  X.  Calhoun  street. 

William  Tarun,  613  Park  avenue. 

R.  Tunstall  Taylor,  2000  Maryland  avenue. 

G.  Timberlake,  Professional  Building. 
Homer  U.  Todd,  1027  X.  Gilmor  street. 
J.  A.  Tompkins,  Jr.,  905  Cathedral  street. 
A.  J.  Underbill.  1812  X.  Charles  street. 
A.  DeT.  Yalk,  Kernan  Hospital. 

Fred  H.  Vinup,  1221  Hollins  street. 


THE    HOSPITAL    BULLETIN 


57 


I.  11.  von  Dreele,  W.  56th  street,  Hampden. 
William  K.  White.  [818  X.  Charles  street. 
R.  (I.  Willse,  1127  Madison  avenue. 
Gordon  Wilson,  1318  N.  Charles  street. 
John  R.  Winslow,  The  Latrobe,  Charles  and 

Read  streets. 

Nathan  Winslow.  3304  Walbrook  avenue. 
Hiram  Woods.  S42  Park  avenue. 


The  annual  smoker  given  by  the  Adjunct  Fac- 
ulty to  the  Senior  Medical  Class  will  be  held  on 
Friday,  May  24,  at  S  1'.  M.,  in  Davidge  Hall, 
Lombard  and  Greene  streets. 


The  commencement  of  the  University  Hospital 
Training  School  for  Nurses  was  held  on  Wednes- 
day,  May  15,  1912,  at  8  I'.  M..  at  Lehmann's  Hall, 
Baltimore. 

The  Program  was  as  follows:  Music.  Prayer, 
Rev.  Arthur  B.  Kinsolving,  T).D.  Music.  Ad- 
dress t"  the  ( Jraduates,  Randolph  Winslow.  A.M., 
M.D..  LL.D.  Music.  Conferring  of  Diplomas. 
R.  Dorsey  Coale.  rh.D.,  Dean  of  the  University. 
Music.    Benediction. 

Those  who  received  diplomas  were: 

Mattie  Estelle  Coale,  Maryland. 

Agnes  May  Lynch,  Florida. 

Marion  Campbell  Smith.  Maryland. 

Alice  Maud  Wells,  Canada. 

Lucy  Lee  Harvey,  Maryland. 

Mary  Juliette  Miles.  Maryland. 

Eulalia  Murray  Cox,  West  Virginia. 

Bernice  Victoria  Conner,  Maryland. 

Lena  Elizabeth  Stouffer,  Maryland. 

May  Katherine  Steiner,  Maryland. 

Eliza  Nalley  Ridgley,  Maryland. 

Ann  Ethel  Logue,  Pennsylvania. 

Lilian  Freeman  Blake.  Maryland. 

Blanche  Louise  Prince,  Maryland. 

Ethel  Mayotta  Dawson,  Maryland. 

Lucy  Marian  Lilly,  Georgia. 


Dr.  George  Yellott  Massenburg,  class  of  191 1. 
formerly  attached  to  the  staff  of  the  Church 
Home  and  Infirmary,  has  been  appointed  a  resi- 
dent surgeon  in  the  Santo  Tomas  Hospital  of 
Panama  Citv,  Panama. 


The  annual  smoker  of  the  General  Alumni  As- 
sociation will  be  held  Friday,  May  31,  in  the  hall 
of  the  Medical  and  Chirurgical  Faculty  of  Mary-* 
land,  121 1  Cathedral  street,  Baltimore.  Gov- 
ernor Goldsborough  has  promised  to  attend,  sub- 
ject to  the  contingencies  of  public  business.  Rev. 
Charles  Fiske,  rector  of  St.  Michael's  and  All 
Angels'  Protestant  Episcopal  Church,  will  speak, 
and  Mr.  Leroy  <  Hdham  will  entertain  with  South- 
ern songs  and  stories.  The  Bentztown  Hard.  Mr. 
Folger  McKinsey,  will  also  be  one  of  the  guests, 
and  Dr.  P..  Merrill  Hopkinson  is  arranging  the 
musical  program.  Tickets  are  $1,  and  are  ob- 
tainable from  Dr.  Nathan  Winslow.  class  of 
1901,  at  O08  Professional  Building. 


Dr.   Anton  G.    Rytina,  class  of   1905.  has  re- 
moved to  The  Shirley,  Baltimore. 


Prof.  Hemmeter,  who  is  himself  an  artist  and 
composer,  lectured  to  the  students  of  the  Pea- 
body  Conservatory  of  Music  on  April  iSth  on 
the  Physiologic  Ftmdamentals  of  Piano  Tccli- 
nique.  He  has  made  this  subject  peculiarly  his 
own.  and  according  to  the  Peabody  Conservatory 
faculty  there  is  no  one  who  can  even  remotely 
control  it  like  our  physiologist.  He  has  received 
the  following  letter  from  Prof.  Harold  Randolph, 
the  director  at  the  Peabody  Conservatory  of 
Music. 

"Dear  Dr.  Hemmeter  : 

"I  have  been  so  busy  and  harrassed  with  our 
Opera  Class  that  until  the  performance  was  over 
I  had  neither  sense  nor  memory.  This  alone  can 
explain  my  delay  in  thanking  you  more  fully  for 
your  most  interesting  and  stimulating  lecture. 

"You  brought  out  man}-  points  that  were  new 
to  us  and  shed  fresh  light  on  many  of  the  old 
ones  upon  which  we  have  been  harping  for  many 
years. 

"I  am  sorry  to  think  that  any  one — either  a 
student  or  teacher — should  have  been  prevented 
from  hearing  it. 

"With  warmest  thanks  from  all  of  us, 
"Very  sincerely  yours. 

Harold  Randolph." 

Prof.  Hemmeter  is  considering  an  invitation  to 
give  three  lectures  on  the  same  subject  at  the 
April  27,  1912,  Cincinnati  Conservatory  of  Music, 
and  one  lecture  each  on  "77k'  Physiol.  Funda- 
mentals of  the  Human  Voice  in  Speaking  and 
Singing."  and  on  "Rhythm  and  Harmony  in  Rela- 
tion to  Auditory  ami  Brain  Physiology." 

A  Philadelphia  publishing  house  has  sent  their 


58 


THE   HOSPITAL   BULLETIN 


representative  with  a  flattering  offer  to  publish 
these  investigations  and  studies  on  the  borderline 
between  music  and  physiology  in  book  form. 


S.  Lynn,  class  of  1907,  have  been  elected  honor- 
arv  members  of  Chi  Zeta  Chi  Fraternity. 


Dr.  John  Guirley  Misseldine,  class  of  1911, 
passed  the  Nebraska  State  Board  medical  exami- 
nations with  third  honors,  and  is  practicing  at 
Oxford,  Neb. 


Dr.  Eugene  Wright,  class  of  1908.  is  superin- 
tendent of  the  Church  Home  and  Infirmary,  Bal- 
timore. 


Leslie's  Weekly,  issue  of  April  4,  1912.  shows 
a  picture  of  the  first  intercollegiate  baseball  game 
of  19 1 2,  being  the  game  played  between  the  Uni- 
versity of  Maryland  and  the  Naval  Academy  on 
March  20,  1912.  The  picture  shows  the  grounds 
crowded  with  spectators. 


Dr.  Harry  Montrose  Slade,  class  of  1884.  of 
Reisterstown.  Md.,  was  appointed  health  officer 
o.f  Baltimore  county,  to  succeed  Dr.  James  F.  H. 
Gorsuch,  class  of  1876,  of  Fork,  Md. 


The  following  alumni  have  been  appointed  dis- 
trict health  officers  of  Baltimore  county : 

First  District— Dr.  Marshall  B.  West,  class  of 

1901,  of  Catonsville. 

Third— Dr.  Henry  Alan  Naylor,  class  of  1900, 
of  Pikesville. 

Fifth— Dr.  Cyril  E.  Fowble,  class  of  1910,  of 
Arcadia,  Md. 

Sixth — Dr.  Joseph  S.  Baldwin,  class  of  1874, 
of  Frecland. 

Seventh— Dr.  Eugene  W.  Heyde,  class  of  1892, 
of  Parkton. 

Eighth — Dr.  Benjamin  Robert  Benson,  class  of 
1873,  of  Cockeysville. 

Ninth — Dr.  Richard  C.  Massenburg,  class  of 
1884,  of  Tow  son. 

Tenth— Dr.  Josiah  T.  Payne,  class  of  1868,  of 
Sunny  Brook. 

Twelfth— Dr.  William  E.  McClanahan,  class  of 

1902,  of  Baltimore. 


Drs.  Randolph  Winslow,  class  of  1873;  A.  M. 
Shipley,  class  of  i<p2;  E.  H.  Kloman,  class  of 
[910;  Nathan  Winslow,  class  of  1901,  and  Frank 


Hyman  R.  Weiner,  senior  medical  student, 
1630  McCulloh  street,  has  been  elected  resident 
physician  at  the  Harrisburg  Hospital,  and  re- 
ceived notification  of  his  election  April  29.  The 
hospital  has  104  beds. 


We  regret  to  note  that  Dr.  Marshall  B.  West, 
class  of  1901,  of  Catonsville,  has  pneumonia. 


Miss  Elizabeth  C.  Patterson,  University  Hos- 
pital Training  School  for  Nurses,  class  of  1911, 
has  resigned  as  assistant  superintendent  of  nurses 
of  the  University  Hospital. 


We  have  been  asked  for  the  addresses  of  the 
following  alumni  of  the  University  Hospital 
Training  School  for  Nurses : 

Miss  Vera  Wright,  class  of  1909,  Presbyterian 

Hospital.  New  Orleans,  La. 

Miss  Mary  Barton  Saulsbury,  class  of  1909, 
Guilford  Apartments,  Baltimore,  Md. 

Miss  Emily  Lavinia  Ely,  class  of  1909,  care  of 
Miss  Flanagan,  Jacksonville,  Fla. 

Miss  Lucy  Briscoe  Barber,  class  of  1910.  1403 
Madison  avenue,  Baltimore,  Md. 

Miss  Gertrude  Anne  Garrison,  class  of  1910, 
"Havendale,"  Burgess  Store,  Ya. 

Miss  Mary  Morgan  Kirnmel,  class  of  1910.  304 
E.  Lafayette  avenue,  Baltimore. 

Miss  Sarah  Lillian  Long,  class  of  1910.  21  X. 
Carey  street,  Baltimore. 

Miss  Lula  Conway  Price,  class  of  1910,  21  X. 
Carey  street,  Baltimore. 

Miss  Florence  Dandlet  King,  class  of  iijio, 
Baltimore  Eye  and  Ear  Hospital,  W.  Franklin 
street,  Baltimore. 

Miss  Sarah  Ambrose  Lee,  class  of  1910,  21  X. 
Carey  street,  Baltimore. 

Miss  Mary  Constance  Wiggin,  class  of  I'M'). 
U.  S.  Xaval  Hospital,  Norfolk,  Ya. 

Miss  Marie  Belle  Murchison,  class  of  1910, 
1403  Madison  avenue,  Baltimore.  Md. 

Miss  Yirginia  Opie  McKay,  class  of  1910,  21 
X".  Carey  street.  Baltimore,  Md. 

Miss  Cora  Nellie  Burton,  class  of  1910.  640  W. 
North  avenue,  Baltimore,  Md. 

Miss  Anne  .Melisse  Drye.  class  of  1910.  21  N. 
Carey  street,  Baltimore,  Md. 


THE    HOSPITAL   BULLETIN 


59 


Miss  Pauline  Brook  Pleasants,  class  of 
311  E.  North  avenue,  Baltimore,  Md. 

Miss   Frances    -May   Meredith,   class  of 
1403  Madison  avenue,  Baltimore,  Md. 

Miss  Margaret  Means  Taylor,  class  of  19 
N.  Carey  street,  Baltimore,  Md. 

Aliss  Adele  Davis  Barrett,  class  of  [910, 
Carey  street.  Baltimore,  Md. 

Miss  Ellen  Coleman  Israel,  class  of  1910 
Madison  avenue.  Baltimore,  Md. 

Miss  Agnes  Kirk  Holland,  class  of  1910, 
Carey  street.  Baltimore,  Md. 

Miss  Naomi  Viola  Hissey,  class  of  [907, 
Carey  street.  Baltimore,  Md. 

Miss  Mary  Erie  Grimes,  class  of  1907, 
Carev  street,  Baltimore,  Md. 


1910, 
1910, 
10.  21 

21  N. 

.  1403 
21  N. 
21  N. 


We  are  glad  to  report  that  Dr.  Frank  S.  Lynn, 
class  of  1907,  who  has  been  ill  with  pleurisy,  has 
sufficiently  recovered  to  be  out  again. 


Dr.  Thomas  A.  Ashby,  class  of  1873,  of  1 1  25 
Madison  avenue,  was  a  guest  in  Lexington,  \  a., 
during  the  past  month.  He  was  initiated  into  the 
Phi  Beta  Kappa  Fraternity,  to  which  he  was  re- 
cently elected,  at  his  Alma  Mater,  Washington 
and  Lee  University.  Phi  Beta  Kappa  is  said  to 
be  the  oldest  Greek  letter  society  in  the  country, 
having  been  established  at  William  and  Mary  in 
1770.  Election  now  is  accorded  only  to  men  of 
eminence  in  their  special  line  of  activity.  Dr. 
Ashby  made  the  trip  by  automobile,  accompanied 
by  Mr.  William  C.  Page,  who  was  his  companion 
1  hi  his  trip  to  Europe  last  year. 


Dr.  Howard  V.  Dutrow,  class  of  1904,  for- 
merly of  Frederick,  Md.,  who  has  been  stationed 
in  the  hospital  at  Ancon,  Canal  Zone,  was  elected 
secretary  and  treasurer  of  the  Medical  Associa- 
tion of  the  Isthmus  Canal  Zone  at  the  regular 
monthly  meeting  of  the  association  held  in  the 
Ancon  Hospital  on  Wednesday  evening,  March 
13,  1912. 

Dr.  Dutrow's  selection  to  the  position  is  quite 
an  honor.  The  association  has  a  membership  of 
over  too  and  is  affiliated  with  the  American  Med- 
ical Association.  It  is  analogous  to  the  Medical 
and  Chirurgical  Faculty  of  Maryland,  and  has  the 
same  designation  as  all   State  associations.     Col. 


W.  C.  Gorgas  is  one  of  the  ex-presidents  of  the 
association. 

For  the  past  six  years  Dr.  Dutrow  has  been  em- 
ployed in  the  medical  service  of  the  United  States 
Government  at  Panama,  and  for  some  time  pasl 
has  been  stationed  at  the  Ancon  Hospital,  the  sec- 
ond largest  hospital  in  the  world,  in  the  capacity 
of  assistant  chief  of  clinic  eye,  ear,  nose  and  throat 
department.  The  Ancon  Hospital  is  the  principal 
Government  hospital  on  the  Isthmus. 


Dr.  Howard  A.  Kelly's  "Clycopedia  of  Ameri- 
can Medical  Biography"  is  deeply  interesting  to 
University  of  Maryland  men.  We  regret  that  a 
sketch  of  Corbiu  Amos  does  not  appear  in  this 
book,  inasmuch  as  we  have  so  long  been  accus- 
tomed to  regard  his  diploma  as  an  "outward  vis- 
ible" evidence  of  the  veneration  in  which  the  be- 
holder should  keep  our  school.  Dr.  Cordell  has 
named  quite  a  few  other  distinguished  Maryland 
physicians  (Old  Maryland,  April,  1912)  whom 
he  deems  more  than  worthy  of  a  place  in  its 
pages,  but,  in  spite  of  its  omissions.  Dr.  Kelly's 
book  will  meet  a  much-needed  requirement  of  the 
medical  profession,  and  will  continue  in  service 
as  an  authentic  record  for  many  generations. 
Among  the  University  alumni  and  professors 
whose  sketches  appear  in  this  book  are : 

Doctors — 

Isaac  Edmondson  Atkinson,  class  of  1865,  late 
dean  of  the  medical  school  of  the  University, 
and  father  of  Dr.  A.  Duvall  Atkinson,  class  of 
1894. 

Ashton  Alexander,  provost  from  1837  to  1850. 

Roberts  Bartholomew,  class  of  1852. 

Henry  Willis  Baxley,  class  of  1824,  one  of  the 
founders  of  the  first  dental  college  in  the  world. 

Alexander  Hamilton  Bayly,  class  of  1835. 

George  W.  Boerstler,  class  of  1820. 

Thomas  Hepburn  Buckler,  class  of  1835. 

Elisha  DeButts,  professor  of  chemistry  in  the 
University  from  1809  (then  the  College  of  Medi- 
cine in  Maryland )  until  his  death,  in  1831. 

James  Cocke,  one  of  the  founders  of  the  Uni- 
versity, partner  of  Dr.  John  Beale  Davidge. 

William  Alexander  Clendenin,  class  of  1S40, 
ophthalmologist. 

Samuel  Chew,  class  of  1829,  professor  of  prin- 
ciples and  practice  of  medicine,  1852-1863,  father 
of  Emeritus  Professor  Chew. 

Julian  J.  Chisolm,  professor  of  surgery  in  the 


6o 


THE    HOSPITAL    BULLETIN 


University,  and  father  of  Dr.  Frances  Miles  Chis- 
olm.  class  of  1889. 

Joshua  I.  Cohen,  class  of  1823,  probably  the 
earliest  aurist  in  America. 

[ohn  Beale  Davidge,  founder  of  the  University. 

Francis  Donaldson,  class  of  1846,  first  profes- 
sor of  physiology  in  the  University  of  Maryland, 
and  father  of  Dr.  Donaldson,  class  of  1883. 
(  To  be  continued.) 


MARRIAGES 

1  )r.  William  Cuthbert  Lyon,  class  of  1907,  was 
married  to  Miss  Bella  Eleanor  Flaccus,  daughter 
of  Mrs.  William  Flaccus  of  Ben  Avon.  Pa.,  on 
Friday,  April  12,  1912,  at  Ben  Avon.  Dr.  and 
Mrs.  Lyon  are  spending  their  honeymoon  in  Eu- 
rope. They  will  be  at  home  in  Baltimore  after 
September  1,  19 12. 


Dr.  Bennett  F.  Bussey.  class  of  1894,  of  Texas, 
Baltimore  county,  Maryland,  was  married  on 
April  26.  1912,  to  Miss  Katherine  M.  Craig, 
daughter  of  Mr.  and  Mrs.  Robert  Craig,  also  of 
Texas.  The  couple  were  married  in  Baltimore 
at  the  residence  of  Cardinal  Gibbons  by  Rev.  R. 
C.  Campbell  of  St.  Joseph's  Catholic  Church  of 
Texas.  The  bride  was  attired  in  a  traveling  suit 
of  steel  gray,  with  black  hat,  and  carried  a  bou- 
quet of  pink  roses  with  a  shower  of  lilies  of  the 
valley.  The  witnesses  were  Miss  Mary  Craig, 
sister  of  the  bride,  and  Dr.  Henry  S.  Jarrett  of 
Towson.  Dr.  Bussev  is  a  former  president  of  the 
Baltimore  County  Medical  Association  and  a 
member  of  the  Medical  and  Chirurgical  Faculty 
'  if  Maryland. 


DEATHS 

David  Thomas  Bowden,  class  of  1889,  chief 
surgeon  of  the  orthopedic  department  of  the  Pat- 
erson  General  Hospital,  died  at  his  home  in  1'at- 
erson,  X.  ].,  March  18,  1912,  aged  46  years. 


Dr.  William  II.  Feddeman.  class  of  1888.  of 
Roland  Park.  Md.,  died  April  12.  1912,  at  the 
Northampton  Court  Hotel,  Baltimore.  Dr.  Fed- 
deman was  a  native  of  Virginia  and  came  to  Bal- 
timore about  20  years  ago.  He  graduated  from 
the  University  with  honors  and  served  in  the  Uni- 
versity Hospital  for  a  time.  He  had  a  large  prac- 
tice, and  of  late  years  his  health  had  begun  to 
break  because  of  overwork.     He  i^  survived  by 


his  wife  and  a  daughter,  Miss  Emma  Feddeman. 

Medical  Director  George  E.  H.  Harmon, 
U.  S.  X.,  class  of  1872,  died  at  Cambridge,  Md., 
March  5,  1912,  aged  64  years.  Dr.  Harmon  en- 
tered the  service  December  20.  1873,  as  an  Assist- 
ant Surgeon,  being  retired  because  of  age  on 
March  5,  1910,  in  the  grade  of  Medical  Director, 
with  rank  of  Captain. 

Dr.  Harmon  was  the  dean  of  the  Medical  Corps 
of  the  Navy.  His  service  afloat  covered  over  17 
years.  He  has  seen  active  duty  in  almost  every 
part  of  the  world,  and  always  did  credit  to  the 
corps  and  his  country.  He  was  in  command  of  the 
Naval  Hospital  at  Yokohama.  Japan,  from  Sep- 
tember 2"j,  1900,  to  December  24,  1902.  and  of  the 
Naval  Hospital  at  Washington,  D.  C,  from  July 
30,  1908,  to  June  20,  1910.  Dr.  Harmon  had  a 
high  sense  of  duty  and  marked  executive  ability. 
He  gave  many  valuable  contributions  to  literature 
on  subjects  of  naval  medicine.  His  kindly  nature 
and  marked  general  and  professional  ability  made 
him  many  friends.  Dr.  Harmon  was  never  mar- 
ried. He  was  an  active  member  of  the  Associa- 
tion of  Military  Surgeons  since  1902. 


Col.  Louis  W.  Crampton,  Medical  Corps.  U. 
S.  A.,  class  of  i8(>o.  died  at  San  Bernandino,  Cal.. 
April   12,  T()i2.   from  pneumonia,  aged  63  years. 

Dr.  Crampton  was  born  in  Maryland  Mav  8. 
1848.  He  graduated  from  the  University  in  (869, 
and  became  an  Assistant  Surgeon  in  the  Army  on 
June  26,  1875.  He  was  granted  the  following 
promotions:  Captain,  June  26,  1880;  Major,  Sep- 
tember 6,  1895;  Lieutenant-Colonel,  August  y, 
1903,  and  Colonel,  April  23.  1908. 

He  served  with  troops  at  Fort  Sheridan,  Fort 
Spokane,  Fort  Meade,  and  in  Washington,  D.  C. 
and  St.  Louis  as  medical  supply  officer.  lie 
served  two  terms  of  duty  in  the  Philippines,  the 
second  as  Chief  Surgeon  of  the  Philippine  Divi- 
sion, and  had  returned  to  the  United  States, 
after  being  relieved  of  this  duty,  and  was  await- 
ing retirement  at  San  Bernandino  when  he  was 
stricken  by  death.  Dr.  Crampton  was  a  member 
of  the  American  Medical  Association. 


As  we  go  to  press  we  learn  of  the  death  on 
Mav  11,  1912,  of  Dr.  Ephriam  Hopkins,  class  of 
1859,  for  many  years  a  practitioner  in  Darlington, 
Harford  county,  Maryland.  Dr.  Hopkins  was  a 
brother  of  Dr.  William  Worthington  Hopkins, 
class  of  1 8^8.  who  died  last  vear. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 
PRICE    &I.OO    PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  608  Professional  Building,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.  VIII 


BALTIMORE,  MD.,  JUNE  IS,   1912. 


No.  4 


ADDRESS  TO  THE  GRADUATES  OF  THE 
TRAINING  SCHO(  >L  FOR  NURSES  OF 
THE  UNIVERSITY  HOSPITAL,  MAY 
15,  i<;i2. 


By   Randolph    Wixsr.ow,   A.M..    M.D..   LL.D. 


Young  Ladies  of  the  Graduating  Class  of  iyu: 
Certain  days  in  our  lives  stand  forth  separate 
from  all  other  days,  and  are  epochs  in  our  his- 
tory. One  such  day  we  are  assembled  to  cele- 
brate on  this  occasion,  the  Commencement  Day 
of  the  class  of  1912.  For  three  long  years  of 
arduous  effort  you  have  looked  forward  to  the 
time,  when  amid  the  plaudits  of  your  friends,  the 
fragrance  of  flowers  and  the  discourse  of  delight- 
ful music,  you  should  receive  the  coveted  di- 
plomas, testifying  that  you  are  qualified  and 
equipped  for  the  exercise  of  your  professional 
calling.  This  time  has  now  arrived,  and  it  is 
my  pleasant  duty  to  extend  to  you  the  hearty 
congratulations  of  your  officers  and  teachers,  as 
well  as  my  personal  felicitations,  upon  the  com- 
pletion of  the  years  of  strenuous  training  and 
■  >f  work  well  done;  and  to  bespeak  for  each  of 
you  a  useful,  honorable  and  successful  career. 
While  your  term  of  pupilage  ceases  with  the 
conclusion  of  these  exercises,  I  wish  to  warn 
you  that  you  must  not  imagine  that  your  days 
1  >f  stud}'  are  over;  in  fact  they  have  but  just 
begun.  You  must  either  go  forward  or  fall  to 
the  rear,  you  cannot  stand  still.  You  have  hith- 
erto been  lead  and  guided,  but  in  the  larger  and 
freer  life  upon  which  you  are  now  entering  you 
will  have  to  assume  individual  responsibility ;  and 
you  must  be  prepared  to  meet  these  responsi- 
bilities as  they  arrive.  You  will  need,  therefore, 
lo  continue  to  study  not  only  text-books  and 
journals,  but  the  various  conditions  of  disease 
with  which  you  come  into  contact,  as  well  as 
the  individual  patients  themselves.  Study  per- 
sistently,    observe    carefully,    and    keep    accurate 


notes  of  your  cases.  Strive  not  only  to  excel  in 
your  professional  work,  but  to  add  to  your  store 
of  knowledge,  and  of  general  culture.  You  have 
chosen  a  life  of  service,  and  you  will  have  to 
sacrifice  ease  and  pleasure  to  a  large  extent.  You 
will  be  brought  in  contact  with  all  kinds  of  people, 
some  of  them  kind  and  considerate,  some  rude 
and  churlish.  To  each  class  you  must  be  patient 
and  gentle,  soft  of  speech,  unruffled  in  temper, 
and  of  unfailing  cheerfulness.  You  must  remem- 
ber that  those  who  are  brought  low  by  sickness 
and  suffering  are  not  altogether  responsible  for 
their  actions  and  words,  and  that  they  may  do 
and  say  that  which  they  would  not  do  or  say 
under  other  circumstances.  You  will  only  too 
often  be  called  upon  to  minister  to  those  who 
are  passing  through  the  valley  of  the  shadow  of 
death,  and  it  may  be  your  duty  and  privilege  not 
only  to  alleviate  their  physical  pain  and  distress, 
but  at  times  to  speak  words  of  hope  and  cheer 
to  those  who  are  without  hope  or  light.  This 
responsibility  may  not  be  avoided  or  lightly  put 
aside,  and  a  ministering  angel  is  she  who  not 
only  soothes  the  anguish  of  those  who  are  about 
to  pass  over  the  river,  but  shows  the  way  of 
salvation  to  those  who  are  perishing.  Cherish 
high  ideals,  have  a  broad  charity,  and  emulate 
the  examples  of  those  noble  women  who  have 
only  recently  been  summoned  to  "come  up 
higher" — Florence  Nightingale  and  Clara 
Barton. 

Florence  Nightingale  may  well  be  called  the 
founder  of  modern  training  schools  for  nurses. 
Previous  to  her  time  nurses  were  usually  well 
meaning  but  ignorant  women,  without  education 
and  devoid  of  the  most  elementary  knowledge 
of  caring  for  the  sick;  often  some  old  crone. 
loquacious  and  egotistical,  who  was  ready  to  do 
the  wrong  thing  whenever  the  opportunity  of- 
fered. Frequently  the  nurse  was  a  loving  mem- 
ber of  the  family,  a  devoted  mother  or  wife,  who 
sacrificed    herself   unselfishly,   but   who    did   not 


62 


THE    HOSPITAL   BULLETIN 


possess  the  necessary  qualifications.  Florence 
Nightingale  was  born  of  English  parents  at  Flor- 
ence, Italy,  in  1820,  and  died  at  London  in  1910, 
aged  more  than  90  years.  She  attended  a  train- 
ing school  for  deaconesses  in  Germany  in  1849, 
and  subsequently  continued  her  studies  in  the 
hospitals  of  London  and  Paris.  Upon  the  out- 
break of  the  Crimean  War  the  cry  came  from  the 
field,  "Are  there  no  devoted  women  among  us 
able  and  willing  to  go  forth  and  minister  to  the 
sick  and  suffering  soldiers  at  the  hospitals  of 
Sentari?"  Miss  Nightingale  responded  and 
selected  38  female  nurses,  and  went  to  the  front. 
They  found  conditions  most  deplorable,  the  hos- 
pitals filthy  and  infected  with  vermin,  and  cholera 
and  pestilence  raging.  Order  was  soon  brought 
out  of  chaos,  new  conditions  were  brought  about, 
and  death  yielded  to  recovery  in  ever  increasing 
proportions.  From  her  custom  of  visiting  her 
patients  at  midnight  she  became  known  as  the 
Lady  with  the  Lamp,  and  has  been  immortalized 
in  the  lines : 

"A   lady   with  a   lamp   shall    stand 
In  the  great  history  of  the  land, 
A  noble  type  of  good, 
Heroic  womanhood." 

She  accompanied  the  troops  into  the  field,  and 
was  often  under  fire,  and  rendered  such  heroic 
service  that  she  became  a  national  heroine,  and 
was  the  recipient  of  the  highest  honors.  A  pop- 
ular subscription  of  $250,000  was  raised  and  pre- 
sented to  her,  which  she  refused  to  accept,  and 
asked  that  it  be  used  to  found  the  Nightingale 
Home  and  School  for  Nurses  at  St.  Thomas' 
Hospital,  London.  Notwithstanding  the  impair- 
ment of  her  health  from  her  work  during  the 
Crimean  War  she  lived  to  a  very  ripe  old  age, 
known  and  honored  the  world  over. 

Clara  Barton  was  born  at  Oxford,  Mass..  in 
1821,  and  died  at  Glen  Echo,  Md.,  in  [912,  aged 
91  years.  She  was  a  school  teacher  at  Borden- 
town,  N.  J.,  but  on  account  of  poor  health  re- 
moved to  the  city  of  Washington  shortly  before 
the  Civil  War,  and  obtained  a  clerkship  in  the 
Patent  Office.  Upon  the  outbreak  of  the  war  she 
volunteered  for  service  in  caring  for  the  sick  and 
wounded,  and  like  Florence  Nightingale  devoted 
herself  to  her  self-imposed  task  with  such  as- 
siduity and  success  that  her  fame  spread  far  and 
wide.  When  war  broke  out  in  1870  between 
Germany  and  France  she  again  responded  to  the 


call  of  humanity  and  rendered  invaluable  services 
to  the  sick  and  wounded.  Upon  her  return  to 
the  United  States  she  succeeded  in  gaining  gov- 
ernmental recognition  of  the  Red  Cross  Conven- 
tion, and  was  chosen  the  first  president  of  the 
American  Red  Cross,  which  position  she  retained 
until  her  death.  These  women  had  a  broad  virion 
of  their  duty  to  humanity  and  they  did  not  shrink 
from  the  performance  of  this  duty  even  at  the 
sacrifice  of  comfort,  health  and  lift-,  if  need 
he.  I  hope  that  we  may  be  spared  the  horrors  of 
war  and  of  the  pestilence  that  walketh  in-  dark- 
ness, but  if  these  calamities  should  befall  us  I 
am  sure  that  you  will  not  fail  to  do  your  duty, 
as  those  of  whom  I  have  just  spoken  did  theirs. 
One  may  be  as  much  of  a  hero,  however,  in  the 
performance  of  the  every-day  duties  of  life  as 
in  the  sudden  and  thrilling  episodes  of  a  spec- 
tacular character.  I  believe  that  a  life  spent 
in  the  service  of  our  fellowmen  will  not  fail  of 
recognition  by  the  Almighty,  and  that  the  ulti- 
mate sacrifice,  the  laying  down  of  one's  life  that 
others  may  live,  will  not  fail  of  its  reward.  In 
the  recent  appalling  disaster  upon  the  sea  some 
met  their  fate  with  words  of  praise  and  of  prayer 
upon  their  lips ;  others  looked  death  in  the  eye 
without  quailing,  and  met  their  doom  doing  their 
best  to  save  the  weak  and  helpless.  May  God 
in  his  boundless  love  have  mercy  upon  them  all. 
Folger  McKinsey,  the  Bentztown  bard,  pays  a 
beautiful  tribute  to  these  heroic  soul-  who  died 
that  others  might  live. 

"I'm  glad,  Jack  Astor,  you  died  that  way! 

Goodby,   Jack   Astor,   Goodby! 
I  am  glad  you  showed  us  what  men  become 

When  they  look  death   straight  in  the  eye. 
You'd  been  a  bad  fellow,  1  guess,  in  a  style 

That  you   didn't  yourself  think  had; 
But  you  died  like  a  thoroughbred  gentleman — 

Goodby,  Jack  Astor,   I'm  glad  !" 

"They  say  he  was  bad,  and   I   guess   he  was, 

But  I  think  God  will  forget; 
There's  a  bit  of  the  bail  in  the  best  of  men. 

And  there's  going  to  lie  lots  of  it  yet: 
But  it  washes  out  in  the  end,  my  friend. 

When  we  try  jack  Astor's  plan, 
Who  saved  the  women  and  saved  the  kids, 

And  turned  and  died  like  a  man." 


THE    HOSPITAL    BULLETIN 


63 


"  "vstor,  and   Archibald  Butt,  and  Case — 

Goodby,  brave  spirits,  goodby! 
Why,  even  the  men  that  live  bj  mistakes 

Arc  gentlemen  when  they  die. 
Soldiers  and  heroes  and  all  that  men 

J n  their  manly  measure  should  be, 
When  they  look  dead  straight  in  the  eye  of  fate 

(  >n  the  land  or  on  the  sea !" 

'Idie  hest  preparation  for  a  heroic  death  is  to 
live  a  godly  life,  and  1  do  not  wish  to  seem  to 
condone  a  careless  life,  even  when  it  culminates 
in  the  greatest  sacrifice  that  one  can  make. 
"Greater  love  hath  no  man  than  this,  that  a  man 
lay  down  his  life  for  his  friends.'*  It  may  be  that 
in  the  supreme  moment  of  self  abnegation  God 
will  forgive  and  forget  our  past  misdeeds.  John 
]  lay  expresses  the  same  sentiment  in  his  poem, 
Jim  Bludsoe. 

"He  weren't  no  saint — hut  at  judgment 

I'd  run  my  chance  with  Jim, 
'Longside  of  some  pious  gentlemen 

That  wouldn't  shook  hands  with  him. 
He  seen  his  duty,  a  dead  sure  thing — 

And  he  went  for  it  thar  ami  then  ; 
And  Christ  ain't  a-going  to  he  too  hard 

On  a  man  that  died  for  men." 

We  live  in  a  momentous  age,  in  fact,  in  the 
most  wonderful  period  of  the  world's  history; 
time  anil  space  are  being  annihilated,  and  the 
viM.ins  of  the  prophets  and  the  dreams  of  the 
poets  are  being  fulfilled.  In  1513  \  asco  Nunez 
de  Balboa,  from  the  crest  of  a  hill  on  the  Isthmus 
of  Panama,  first  saw  the  vast  ocean  lying  at  his 
feet,  which  on  account  of  its  tranquility  he 
called  pacific,  and  Pacific  (  teean  it  has  remained 
to  this  day.  Soon  the  thought  was  entertained 
of  connecting  the  Atlantic  and  Pacific  <  (ceans  by 
means  of  an  artificial  waterway,  and  now  the 
dream  of  the  centuries  is  an  almost  accomplished 
fact.  The  voyage  of  Columbus  in  1402  was  for 
the  purpose  of  discovering  a  more  direct  route 
from  Europe  to  the  Indies,  and  he  went  to  his 
grave  with  his  hopes  unrealized.  In  our  day  the 
fulfillment  of  his  dream  is  at  hand.  The  con- 
struction of  the  Panama  Canal  is  the  most  stu- 
pendous engineering  undertaking  that  the  world 
has  ever  seen,  and  with  its  completion,  a  little 
more  than  a  year  hence,  the  greatest  triumph 
of  mind  over  matter  will  have  occurred.  This 
triumph  will  have  been  accomplished  by  means 
of  American  brains  and  American  money.    What 


has  enabled  our  countrymen  to  successfully  ac- 
complish this  colossal  task,  which  the  French 
undertook  and  gave  up  in  despair?  The  French 
had  the  necessary  engineering  ability,  and  they 

expended  vast  treasure  in  the  undertaking,  but 
they  were  not  able  to  compete  with  the  pestilential 
diseases  of  the  Isthmus,  and  their  employes  died 
like  flies.  It  is  on  account  of  the  better  sanita- 
tion inaugurated  by  the  Americans  that  the  canal 
has  been  built.  The  Isthmus  of  Panama,  like 
Cuba,  Porto  Rico  and  the  Philippine  Islands,  has 
become  a  location  in  which  men  can  live  and 
work  in  as  much  safety  and  in  almost  as  much 
comfort,  as  in  the  temperate  zones.  I'm-  this 
change  from  a  tropical  inferno  to  a  tropical  para- 
dise the  University  of  Maryland  is  to  a  large 
extent  responsible,  and  by  this  change  the  con- 
struction of  the  canal  has  been  made  possible. 
In  1891  James  Carroll,  an  enlisted  man  in  the 
United  States  Army,  graduated  from  the  Medical 
School  of  this  University,  and  in  [899  he  was 
appointed  a  member  of  the  yellow  fever  commis- 
sion, whose  duty  it  was  to  investigate  the  cause 
and  prevention  of  yellow  fever,  lie  voluntarily 
subjected  his  hand  to  the  bite  of  a  stegomia  mos- 
quito that  had  bitten  a  yellow  fever  patient,  and 
promptly  contracted  the  disease,  and  in  his  own 
person  proved  his  faith  that  yellow  fever  is  con- 
veyed from  person  to  person  by  means  of  this 
variety  of  mosquito,  and  by  no  other  means.  By 
destroying  the  breeding  places  of  the  mosquitoes, 
and  by  screening  the  habitations  of  persons  liv- 
ing in  the  tropics,  yellow  fever  has  been  prac- 
tically wiped  out,  as  has  malaria  also.  All  honor 
to  Carroll,  and  to  Lazear,  and  to  Reed,  the  other 
American  members  of  the  yellow  fever  commis- 
sion, all  of  whom  have  passed  from  works  to 
rewards. 

Xot  only  in  Panama,  but  in  various  parts  of 
our  own  country,  we  see  stupendous  undertak- 
ings inaugurated  and,  in  a  few  years,  carried  to 
a  successful  completion  ;  so  that  the  physical  char- 
acteristics of  the  land  are  in  many  places  being 
entirely  transformed.  The  great  miasmic 
swamp  area  of  Florida,  known  as  the  Everglades, 
is  being  drained,  and  a  vast  tract  of  ooze  and 
slime,  where  alligators  and  reptiles,  with  furtive 
Indians,  hold  sway,  will  soon  be  added  to  the 
productive  lands  of  the  country.  In  passing  I 
may  say  that  this  reclamation  is  being  accom- 
plished by  .Mr.  Frank  Furst,  a  citizen  and  resi- 
dent of   this  city.      On   the  other   hand,   the  Vast 


64 


THE    HOSPITAL    BULLETIN 


arid  areas  of  our  Western  domain  are  being  ren- 
dered fertile  and  productive  beyond  comprehen- 
sion by  the  impounding  of  the  mountain  streams 
into  artificial  lakes,  and  the  irrigation  of  the 
waterless  lands.  As  one  travels  through  New 
Mexico,  Arizona,  Nevada  and  other  far  Western 
States,  he  crosses  vast  tracts  of  dry  alkaline 
plains,  where  the  dust  is  stifling  and  the  heat 
like  that  of  a  fiery  furnace ;  where  no  foliage  is 
to  De  seen  except,  perhaps,  gray  sage  bushes 
and  thorny  cacti,  and  where  the  ground  is  cracked 
and  parched  and  uttering  its  prayer  for  rain. 
If  by  chance  some  one  with  a  vision  hears  the 
cry  and  brings  water  to  these  thirsty  deserts, 
they  blossom  as  the  rose  and  bring  forth  some 
thirty,  some  sixty  and  some  many  hundred  fold. 

The  vivid  flash  of  the  lightning  as  it  extended 
across  the  heavens,  associated  with  the  deafening 
crash  of  thunder,  has  brought  terror  to  many 
from  time  immemorial.  It  seemed  to  the  af- 
frighted spectator  that  the  wrath  of  God  was 
about  to  be  visited  upon  the  earth,  and  that  sin- 
ful men  were  to  be  overwhelmed  by  the  righteous 
indignation  of  the  Almighty.  Benjamin  Franklin 
saw  a  vision,  and  from  his  experiments  in  1746 
with  his  kite  we  have  the  electricity  harnesed 
and  made  to  serve  the  useful  purposes  of  man. 
In  1844  Samuel  F.  B.  Morse,  already  an  artist 
of  note,  succeeded  in  interesting  the  Government 
in  a  device  of  his  invention,  and  the  first  tele- 
graphic message  in  the  world,  "What  hath  God 
wrought,"  was  sent  over  the  wires  from  Wash- 
ington to  Baltimore.  The  submarine  cable  now 
connects  the  nations  of  the  world  with  each 
other  as  with  friendly  hand  clasps  beneath  the 
sea;  and  the  telephone  enables  us  to  hear  the 
voice  of  loved  ones  who  may  be  many  hundred 
miles  away.  A  few  years  ago  the  Italian,  Mar- 
coni, succeeded  in  sending  messages  through  the 
air  and  over  the  seas,  without  wires,  and  this 
invention  is  of  the  most  far-reaching  importance. 
The  recent  tragedy  of  the  sea,  the  wreck  of  the 
leviathan  Titanic,  was  robbed  of  some  of  its 
horror  by  the  heroic  devotion  to  duty  of  its 
wireless  operator,  Phillips,  who  continued  to 
send  out  the  cry  for  help,  until  the  great  ship 
plunged  beneath  the  waves,  and  he  met  his  fate 
in  the  icy  waters.  The  call  was  heard,  however. 
and  more  than  700  lives  were  saved. 

Who  has  not  admired  the  wonderful  flight  of 
the  eagle  or  the  soaring  of  the  vulture,  and  how 
many   persons  have   dreamed  of  flying  through 


the  air?  Those  mythological  personages,  Dae- 
dalus and  Icarus  are  represented  to  have  at- 
tempted flight  from  Crete  to  Sicily  with  wings 
made  of  feathers  and  wax.  The  youthful  Icarus 
flew  too  high,  and  the  heat  of  the  sun  melted 
the  wax  and  he  fell  into  the  sea  and  was  drowned, 
but  the  more  prudent  Daedalus  kept  at  a  lower 
level  and  reached  his  destination  in  safety.  Since 
that  time  men  have  not  trusted  themselves  to 
wings  of  feathers  and  wax,  but  the  dream  of 
flight  through  the  air  has  been  entertained  from 
time  to  time  as  an  object  not  beyond  successful 
accomplishment.  Through  the  genius  of  Count 
Zeppelin  the  dirigible  airship  has  become  a 
reality,  and  regular  passenger  service  is  main- 
tained between  certain  cities  in  Germany.  It  is, 
however,  still  a  hazardous  and  uncertain  voyage, 
and  one  can  embark  more  safely,  though  more 
slowly,  in  an  ox-cart.  A  few  years  ago  Orville 
and  Wilbur  Wright  saw  a  vision,  and  the  heavier 
than  air  aeroplane  was  evolved,  and  though  far 
from  perfect  at  present,  C.  P.  Rogers  was  able 
to  cross  from  the  Atlantic  to  the  Pacific  Coast 
at  a  speed  of  more  than  a  mile  a  minute.  These 
are  some  of  the  wonderful  results  that  have 
been  accomplished  in  our  day,  by  those  who 
have  seen  visions  and  have  followed  the  light. 
Many  others  equally  as  startling  might  be  men- 
tioned, did  time  and  opportunity  permit.  Truly 
the  impossible  is  being  made  possible,  and  in  our 
time  is  the  prophecy  being  fulfilled,  that  "it  shall 
come  to  pass  in  the  last  days,  saith  God,  I  will 
pour  out  of  My  spirit  upon  all  flesh  *  *  * 
and  your  young  men  shall  see  visions,  and  your 
old  men  shall  dream  dreams."  I  have  preached 
you  a  very  drowsy  and  prosaic  sermon,  and  I 
must  not  tax  your  forbearance  farther. 

Let  duty  be  the  guiding  spirit  of  your  lives. 
Be  faithful  in  little  things,  and  if  a  great  and 
overwhelming  crisis  should  overtake  you,  you 
will  be  faithful  even  unto  death.  Be  loyal  to 
yourselves,  to  your  school,  to  your  patrons  and 
to  your  calling.  Have  a  broad  vision ;  look  up 
and  not  down.  Observe  the  signs  of  the  times, 
and  go  forward.  Be  hopeful  and  helpful.  A 
life  of  service  to  others  is  the  ideal  life.  Success 
is  relative  and  depends  upon  the  point  of  view. 
The  most  successful  life  is  the  one  of  the  greatest 
usefulness. 

In  this  broad  sense  I  again  wish  you  useful, 
honorable    and   successful  careers. 


THE   HOSPITAL   BULLETIN 


65 


SOME  FACTS  DEALING  WITH  THE  DE- 

VELOPMENT  OF  ASEPTIC 

SURGERY.* 


By  R.  A.  AllgooPj  '12. 


The  first  record  of  surgery  \vc  have  is  400 
years  B.  C,  or  the  time  of  Hippocrates,  who  is 
generally  known  as  the  Father  of  Medicine,  but 
I  think  he  lias  a  just  right  to  he  called  the  Father 
hi  Surgery,  for  he  discoursed  wisely  and  elabo- 
rately of  fractures,  of  joints,  of  the  structures 
and  diseases  of  the  tones,  of  ulcers,  of  fistulas  and 
hemorrhoids.  In  addition  to  this,  his  writing' 
deals  with  trephining,  with  reduction  of  hernia, 
with  herniotomy  and  lithotomy  by  both  the  peri- 
neal and  suprapubic  route. 

lie  descrihed  pneumothorax  and  opened  and 
drained  the  chest  for  empyema. 

This  was  a  good  start  on  the  road  to  success 
of  surgery,  but  the  traveling  was  slow  until  the 
century  that  is  immediately  behind  us,  which 
brings  with  it  memories  we  are  not  likely  to 
forget. 

,  Twelve  years  ago  we  began  the  present  century 
by  celebrating  the  achievements  of  the  last  cen- 
tury, and  the  more  we  inspect  those  100  years  of 
progress,  the  more  remarkable  they  appear. 

In  1894  Billings  wrote:  "More  progress  in  the 
art  of  surgery  has  been  made  since  1800  than  had 
been  made  in  the  2000  years  preceding  that  date." 
And  I  think  that  all  men  of  today  will  agree  that 
Joseph  Lister  has  been  the  leading  factor  in  the 
progress. 

He  was  born  on  April  6,  1827,  at  Upton,  in 
Essex  county.  England.  He  is  not  a  Scotchman. 
as  many  think,  though  his  notable  work  was  done 
in  Scotch  universities. 

Joseph  Lister  followed  his  father's  trade  as  a 
wine  merchant  in  London  for  a  while  after  his 
father's  death,  but  in  spite  of  the  claims  of  busi- 
ness he  felt  the  claims  of  science  more  strongly. 

One  cannot  say  just  when  it  was  that  Lister 
began  constantly  turning  his  mind  to  the  problem 
of  a  remedy  for  wound  infection — perhaps  he 
himself  could  not  tell  us — but  he  must  have  been 
dwelling  upon  such  things  very  early  in  his  career. 

We  may  conceive  of  the  conditions  in  those  old 
hospitals  and  in  wounds  in  general  from  the  de- 


*Kead  before   Randolph   Wiuslow    Suglcal     Society,    ftfarcb 

22    1012 


scription  in  the  books  and  from  the  tales  of  men 
whose  professional  memories   go  back   35   years 

or  more. 

In  (he  hospital  surgical  sepsis  ran  until  sec- 
ondary hemorrhage,  erysipelas,  septicemia,  pye- 
mia and  hospital  gangrene  were  endemic  ;  some- 
times wards,  wings  or  whole  institutes  were  closed 
i:i  vain  attempts  to  stamp  out  these  disorder^. 
(  Iperations  in  private  houses,  especially  in  the 
country,  were  less  dangerous  than  in  hospitals, 
but  in  private-house  operations  the  mortality  was 
high. 

Sometimes  a  surgeon  would  wear  the  same  old 
operating  coat  for  years,  and  would  pick  waxed 
ligatures  from  the  button-hole  of  his  assistants, 
who  carried  them  there  for  the  convenience  of  his 
chief.  Old  hands  will  tell  you  such  stories  by  the 
score,  but  to  the  modern  surgeon  such  practices 
are  uucondonable.  The  explanation  the  men  of 
the  early  part  of  the  eighteenth  century  gave  of 
septic  fevers  was  that  all  septic  fevers  are  due  to 
sympathetic  action  of  the  nervous  system,  as  when 
a  part  is  injured  nature  contends  for  a  cure  by 
stopping  the  function  of  all  the  uninjured  organs, 
and  thus  turning  aside  their  blood  supply  to  the 
injured  part,  setting  up  inflamation  and  so  at- 
tempting a  cure. 

Lister  remained  in  Edinburgh  in  the  early  part 
of  his  life  until  i860,  his  thirty-fourth  year,  and 
it  was  during  the  last  of  this  period  that  he  began 
his  bacteriological  studies  in  connection  with 
aseptic  surgery.  With  an  eye  single  to  this  great 
problem,  he  kept  a  lookout  for  what  the  rest  of 
the  world  was  doing,  and  it  was  at  this  time  that 
the  significant  researches  of  Pasteur  attracted  him. 
Louis  Pasteur  was  five  years  Lister's  senior.  The 
son  of  an  old  Peninsula  war  veteran,  he  was  well 
educated  for  a  scientific  career,  and  by  i860  he  had 
convinced  himself  of  the  importance  of  the  role 
played  by  microbes  in  the  production  of  fermenta- 
tion as  opposed  to  the  old  views  of  Liebig  that 
it  is  a  change  in  organic  fluids  and  tissues  set  in 
motion  by  the  excess  of  oxygen  of  bodies  in  a 
state  of  decomposition.  After  the  demonstration 
of  the  cause  of  fermentation,  there  followed  ex- 
periments and  discussions  on  spontaneous  genera- 
tion and  the  establishment  of  Pasteur  thesis  of 
the  non-existence  of  such  generation. 

Lister's  growing  belief  in  an  external  agent 
as  the  cause  of  wound  infection  was  strengthened 
and  confirmed  by  Pasteur's  researches,  for  in  1867 
he  was  able  to  write.     Turning  now  to  the  ques- 


66 


THE    HOSPITAL    BULLETIN 


tion  how  the  atmosphere  produces  decomposition 
of  organic  substances,  we  rind  that  a  flood  of  light 
has  been  thrown  upon  this  most  important  sub- 
ject by  the  researches  of  Pasteur. 

He  believed  at  this  time — and  for  many  years 
afterwards — that  the  air  was  the  vehicle  which 
brought  poison  to  wounds,  though  he  recognized 
then — and  with  increasing  perception  as  the  years 
passed — that  all  foreign  substances,  as  clothing, 
skin,  instruments,  sponges,  ligatures,  were  also 
contagion  carriers.  Even  before  finding  a  satis- 
factory antiseptic,  he  insisted  that  operators  and 
dressers  should  be  scrupulously  clean,  and  he  em- 
ployed many  deodorant  lotions  about  the  wounds. 

He  had  then  decided  that  putrefaction  and  sup- 
puration were  distinct  processes,  and  were  due  to 
distinct  causes.  He  regarded  wound  infection  as 
putrefaction,  and  what  wonder,  considering  that 
putrefaction  did  frequently  occur  and  simulate 
inflammation  of  the  most  virulent  type! 

The  science  of  bacteriology  was  in  its  infancy. 
and  no  one  appreciated  the  different  forms  of 
i  irganisms,  much  less  the  distinction  between 
pathogenic,  pyogenic  and  saprophytic  bacteria. 

At  this  time  Lister's  ingenuity  was  exercised 
especially  in  some  cases  of  compound  fractures  in 
which  the  mortality  had  always  been  great,  and 
it  was  in  such  cases  in  1864  that  he  proposed  to 
use  his  new  remedy.  He  recognized  that  the  most 
severely  lacerated  simple  fractures  healed  with- 
out special  disturbance,  and,  convinced  as  he  was 
that  it  was  the  air  admitted  to  compound  frac- 
tures which  rendered  them  dangerous,  he  sought 
to  reduce  them  to  the  simple  state  by  excluding 
air  or  by  opposing  to  the  air  a  barrier  which 
should  render  harmless  its  offending  germs.  So 
lie  wiped  out  the  wound  with  pure  carbolic  acid 
and  then  sealed  it  with  lint  soaked  in  carbolic  acid. 
The  exudation  mingling  with  the  acid  formed  a 
paste  which  soon  hardened  into  a  scab.  In  order 
to  prevent  too  rapid  evaporation  of  the  agent,  he 
laid  over  this  dressing  a  block-tin  shield.  So  long 
as  active  inflammation  did  not  appear,  the  car- 
bolic scab  was  painted  daily  with  more  carbolic, 
to  keep  in  a  fresh  supply  of  the  germicide,  and  the 
shield  was  reapplied  daily.  The  surprising  suc- 
cess of  this  treatment  in  the  cases  of  compound 
fractures  led  to  its  employment  in  abscesses  and 
fresh  wounds. 

Sometimes  it  was  impossible  to  secure  exudate 
of  proper  quality  to  mix  with  the  carbolic  for  a 
paste,  so  an  artificial  paste  of  linseed  oil,  carbonate 


of  lime  and  carbolic  acid  was  tried.  This  was 
Lister's  famous  antiseptic  putty. 

Until  1877  antiseptics  came  and  went;  the  car- 
bolic spray  was  used  and  was  banished.  Air  was 
found  not  to  be  a  dreaded  enemy  and  carrier  of 
disease,  but  a  kindly  friend  when  properly  used. 

Surgical  cleanliness,  a  germ-free  environment, 
became  recognized  as  the  one  thing  needed. 

So  today  we  have  aseptic  surgery  in  the  place 
of  septic  surgery,  because  heat,  soap  and  water, 
the  nailbrush,  alcohol  and  a  few  simple  chemicals 
have  replaced  the  use  of  non-sterile  instruments, 
sutures  and  dirty  hands,  all  of  which  go  to  make 
the  past  century  one  of  progress  in  relation  to  sur- 
srerv. 


The  following  postal  was  received  from  Dr. 
Michael  Manna,  class  of  iQio,  of  Tanta,  Egypt : 

"Dear  Dr.  Nathan  Winslow: 

"Yesterday  I  sent  you  by  mail  $5.  Please  for- 
ward one  of  them  to  Dr.  Cordell  for  Old  Mary- 
land, and  the  rest  are  what  George  and  myself 
owe  to  the  Bulletin. 

"If  I  can  get  spare  time,  I  will  collect  from  be- 
tween my  papers  the  scattered  notes  I  have  on 
two  operations  I  performed  lately  and  send  them 
to  you.  One  of  them  is  a  Caesarian  section  on 
a  woman  25  years  old  for  a  contracted  pelvis. 
Am  sure  you  will  be  surprised  to  hear  me  calling 
it  a  bloodless  operation.  Only  a  few  small 
sponges  were  used  from  the  beginning  to  the  end. 
The  other  operation  is  peculiar  for  its  rarity. 
It  was  a  large  abscess  of  the  spleen  complicating 
malaria.  I  had  to  perform  a  laparotomv  for  it. 
The  abscess  contained  about  two  pints  of  pus ; 
the  whole  spleen  looked  like  a  bag  of  pus  floating 
freely  in  the  abdomen.  Result  is  splendid  in  both 
operations. 

"Best  regards  to  you,  Profess  >r>  Winslow. 
Coale.  Mitchell,  Shipley  and  all." 


Dr.  Joseph  Collins,  class  of  1909.  of  Calvert. 
Cecil  county,  Md.,  was  seriously  injured  in  a 
runaway  June  3.  His  buggy  was  overturned  and 
he  lay  for  several  hours  before  someone  found 
him  and  carried  him  to  a  nearby  house.  His 
head  is  badly  cut,  and  his  knee  sprained,  and  it 
will  be  weeks  before  he  will  be  able  to  resume 
his  practice. 


Dr.  John  Willis  Abbitt.  class  of  iqio,  has  been 
appointed  a  coroner  in  Portsmouth,  Ya. 


THE    HOSPITAL    BULLETIN 


07 


BREAST  AFFECTIONS— A  SERIES  OF  ioo 

CASES. 


By  Randolph  WinsloWj  M.D..  LL.D., 

Professor  of  Surgery,  University  of  Maryland, 

and 

Nathan   Winslow,  A.B.,  M.D., 

Associate  Professor  of  Surgery  in  the  University 

of  Maryland. 


From  a  series  of  ioo  cases  of  affections  of  the 
breast  occurrng  in  the  University  Hospital  dur- 
ing the  past  few  years,  we  have  been  able  to  elicit 
the  following  facts :  Sixty-three  were  carci- 
nomas, 3  sarcomas,  20  fibroadenomas,  3  adeno- 
cystomas, t  adeno-fibro-cystoma,  1  systic  fibro- 
ma, 2  galatoceles,  3  tubercular  mastitis,  1  peri- 
canilicular  fibro-myxoma,  abscess  3. 

All  but  one  were  women,  or  99  per  cent.;  the 
male  had  a  fibro-adenoma ;  69  of  the  patients  were 
married,  27  single ;  the  social  status  of  4  was  not 
recorded  ;  88  were  of  the  white  race,  12  of  the  col- 
ored ;  76  did  housework,  the  occupation  of  10  was 
not  stated:  one  was  a  farmer,  2  sales  women,  1  a 
stenographer,  1  a  cook,  1  a  factory  hand,  3  laun- 
dresses, 1  a  dressmaker,  2  were  teachers,  1  a  clerk, 
1  a  music  teacher. 

The  right  breast  was  affected  in  40  instances, 
the  left  in  58 ;  in  the  remaining  instances  the  af- 
fected organ  was  not  mentioned ;  94  of  the  indi- 
viduals were  subjected  to  operation,  with  92  oper- 
ative recoveries  ami  2  deaths.*  Two  refused  op- 
eration, and  in  4  the  involvement  was  too  exten  - 
>ive  for  an  operation. 

The  tumor  came  under  the  observation  of  the 
surgeon  within  the  first  week  of  its  discovery  by 
the  patient  in  five  instances ;  within  one  month  in 
5;  within  two  months  in  6;  within  three  months 
in  9 ;  four  months  3 ;  five  months  1 ;  six  months 
7  ;  nine  months  4  ;  one  year  6 ;  two  years  16 ;  three 
years  5 :  four  years  2 ;  five  years  1  :  six  years  2 : 
seven  years  2 ;  fourteen  years  1  ;  eighteen  years  1  . 
twenty-eight  years  1  ;  not  stated  13. 

Taking  the  series  as  a  whole,  the  largest  num- 
ber of  cases  came  under  the  observation  of  the 
>urgeon  during  the  third  decade  of  life,  there  hav- 
ing been  25  between  30  and  40  years  of  age,  while 
the  fourth  decade  presented  a  nearly  equal  propor- 
tion, with  2^  cases:  48  per  cent,  of  all  the  cases 


♦Deaths.  One  followed  a  palliative  operation  and  oc- 
curred quite  suddenly:  cause  unknown.  The  other  prob- 
ably resulted  from   pneumonia. 


came  to  the  hospital  for  treatment  during  the  pe- 
riod between  30  and  50  years  of  age. 

Carcinoma:  The  cases  of  carcinoma  were  63  in 
number.  The  period  of  greatest  frequency  was  in 
the  fourth  decade,  when  19  cases  occurred,  which 
corresponds  with  previous  statistics.  Of  this  se- 
ries only  3  occurred  before  the  thirty-fifth  year,  56 
at  a  later  period,  3  not  being  recorded ;  10  oc- 
curred before  the  fortieth  year,  49  afterwards. 
The  youngest  age  recorded  was  17  years.  In 
this  case  a  supposedly  fibro-adenoma  was  re- 
moved, but  a  microscopical  examination,  made 
by  I'rof.  Hirsh,  showed  the  tumor  to  be  under- 
going beginning  adeno-carcinomatous  changes. 
The  next  youngest  in  our  series  was  26  years 
of  age.  Fifty-seven  of  the  59  cases  with  age 
recorded  occurred  after  the  thirtieth  year  of  age. 
The  oldest  patient  was  82  years  old ;  she  was  op- 
erated on  and  made  a  good  operative  recovery. 
(  )f  the  12  colored  patients  in  the  general  list,  7 
were  affected  with  carcinoma,  or  58.3  per  cent. 
The  youngest  of  these  was  37  years  of  age.  These 
figures  seem  to  indicate  that  in  the  colored  race 
cancer  is  not  only  relatively  less  frequent,  but  is 
also  actually  less  prevalent  than  in  the  white,  for 
of  the  88  white  patients,  55  were  the  subjects  of 
carcinoma,  62.5  per  cent.,  as  compared  with  58.3 
per  cent,  for  negroes.  A  family  history  of  can- 
cer was  obtained  in  16  instances,  and  of  trauma 
in  14.  The  growth  had  ulcerated  in  10,  and  was 
attached  to  the  skin  or  muscles  in  26.  The  axil- 
lary glands  were  palpable  in  32.  The  growth  was 
located  in  the  upper  and  outer  quadrant  in  15, 
lower  and  outer  in  6,  upper  and  inner  in  9,  lower 
and  inner  in  1.  The  size  varied  from  that  of  a 
marble  to  a  clenched  fist,  and  even  larger  in  sev- 
eral instances.  The  growths  were  removed  by 
llalsted's  radical  method  in  37  instances,  and  by 
Meyer's  method  once;  the  breast  and  axillary 
glands  without  removal  of  the  pectoral  muscles 
in  19.  In  3  involvement  was  too  extensive  for 
successful  removal,  and  2  refused  operation. 

The  importance  of  subjecting  every  growth  to 
a  thorough  microscopical  examination  was  dem- 
onstrated by  the  following  case:  The  operator, 
thinking  he  was  dealing  with  a  fibro-adenoma. 
enucleated  the  growth,  but  subsequently  he  was 
informed  the  growth  was  carcinomatous,  and  the 
patient  returned  for  a  breast  amputation.  In  an- 
other instance,  after  having  removed  a  doubtful 
growth,  the  operator  was  advised  that  a  frozen 
section  indicated  carcinoma.     He  therefore  im- 


68 


THE    HOSPITAL    BULLETIN 


mediately  performed  a  radical  operation,  and 
later  was  informed  that  the  growth,  on  further 
microscopical  examination,  was  innocent.  Thus 
even  frozen  sections  are  not  invariably  reliable, 
but  under  such  circumstances  as  mentioned  above 
it  is  the  best  policy  to  remove  the  breast  at  the 
time  of  the  original  operation  and  not  delay,  even 
though,  as  in  this  case,  the  operative  procedures 
were  more  mutilating  than  was  necessary. 

The  diagnosis  appended  to  the  charts  in  the 
cancer  series  was  simple  carcinoma,  37 ;  sirrhus 
carcinoma,  20 ;  medullary  carcinoma,  1  ;  adeno- 
carcinoma, 5.  In  eight  instances  there  was  a  his- 
tory of  post-operative  recurrence,  but  as  no  post- 
operative history  was  obtained  of  most  of  the 
cases,  a  definite  statement  cannot  be  made  as  re- 
gards the  actual  number  of  recurrences. 

A  history  of  more  or  less  pain  was  obtained 
from  42  of  these  patients. 

In  the  cancer  series  a  growth  was  known  to 
have  been  in  existence  for  the  following  periods: 
One  week,  in  9  cases ;  two  weeks,  in  1  ;  three 
weeks,  1  ;  two  months.  2;  three  mouths,  8;  four 
months,  4 ;  six  months,  5  ;  nine  months,  3 ;  one 
year,  10;  two  years,  10;  three  years,  4;  four 
years  1  ;  five  years,  1  ;  seven  years,  2 ;  fourteen 
years,  1  ;  twenty-eight  years,  I. 

Glancing  at  the  length  of  existence  of  the  tumor 
in  the  cancer  series,  forcibly  reminds  us  that  as 
soon  as  a  lump  is  discovered  in  the  breast  it 
should  be  removed.  In  one  case  the  growth  wa- 
in existence  for  5  years,  two  for  7  years,  one  for 
14  years,  one  for  28  years,  and  quite  a  number 
from  one  to  two  years.  Surely,  if  all  of  these 
had  been  extirpated  in  their  incipiency,  at  least 
some  of  the  cancer  victims  would  have  escaped. 

Sarcoma:  There  were  three  cases  of  sarcoma. 
The  time  of  life  at  which  they  occurred  was  as 
follows:  34  years,  51  years  ami  52  years.  Al- 
though this  series  is  very  small,  the  ages  are 
rather  remarkable.  Sarcoma,  as  a  rule,  occurs 
before  the  fortieth  year.  Here  we  have  two  after 
the  fiftieth.  One  of  these  cases  was  a  myxo-sar- 
coma.     There  was  pain  in  two. 

Adeno-Fibroma:  There  were  20  cases  of 
adeno— fibroma,  distributed  as  follows :  The  old- 
est patient  with  adeno-fibroma  was  45.  The 
greatest  number  of  cases  occurred  between  the 
ages  of  30  and  40,  during  which  decade  nine  cases 
came  under  observation.  To  our  mind,  there  is 
no  doubt  that  some  of  these  tumors  would  have 
eventually  undergone  malignant  degeneration   if 


they  had  not  been  extirpated.    There  was  pain  in 
six  of  these  cases. 

Fibro-Myxoma:  There  was  one  case  of  libro- 
myxoma,  occurring  in  a  colored  girl  aged  17 
years. 

Cystic-Fibroma:  One  case  of  cystic-fibroma 
was  observed,  occurring  in  a  white  woman  27 
years  of  age.    There  was  pain  in  this  case. 

Tubercular  Mastitis:  There  were  three  cases 
of  tuberculosis  of  the  breast,  occurring  at  the  fol- 
lowing ages:  40,  44  and  60.  Of  these  three 
cases  twowere  mistaken  for  malignant  disease  and 
one  was  correctly  diagnosed  clinically.  The  diag- 
nosis in  the  other  cases  was  made  by  means  of 
microscopical  examination.  There  was  some  pain 
in  all  these  cases.  The  last  case  two  years  sub- 
sequently returned  to  hospital  complaining  of  se- 
vere pains  in  right  breast.  On  examination  no 
lump  was  palpable  :  the  breast  soft  and  apparently 
not  affected;  it  was,  however,  amputated,  with 
nu  relief  of  pain. 

Galatocele:  Two  cases  of  galatocek-  were  ob- 
served, occurring  at  the  following  age-:  one  at 
2},  years  and  one  at  35  years.  There  was  pain 
in  one  of  these  cases. 

Adeno-cystoma:  There  were  three  cases  of 
adeno-cystoma,  aged,  respectively,  16.  21  and  47 
years.  There  was  pain  complained  of  in  two  of 
these  cases. 

Adeno-fibro-cy stoma:  One  case  of  adeno-fibro- 
cystoma  was  observed,  aged  51  year.-. 

Ether  was  used  as  an  anesthetic  in  practically 
all  cases,  but  in  one  serious  case  the  induction  of 
insensibility  to  pain  by  the  use  of  I  IMC  tablet- 
was  thoroughly  tested.  At  0  A.  M.  hyocine  gr. 
1/200,  cactine  gr.  1/134.  morphine  gr.  's  was  ad- 
ministered hypodermically,  and  the  same  dose  was 
repeated  at  10.30  A.  M.  When  brought  to  the  oper- 
ating table  at  10.45  A.  M.  the  patient  was  asleep, 
but  could  be  awakened  sufficiently  t<>  understand 
what  was  said  to  her.  and  would  protrude  her 
tongue  if  told  to  do  so,  but  would  not  -peak  in 
answer  to  questions,  and  would  lapse  immediately 
into  slumber.  The  plantar  reflex  was  present : 
the  pupils  were  dilated ;  the  respirations  were 
deep  and  the  pulse  was  full  (120  per  minute), 
but  regular  and  of  good  tension  and  volume.  The 
breast  and  axillary  glands  were  removed  with- 
out great  inconvenience  to  the  patient.  When  re- 
turned to  bed  she  continued  to  sleep  profoundly 
not  awakening  until  5  P.  M.,  when  she  regained 
consciousness  without  nausea  or  other  bad  effect. 


THE    HOSPITAL    BULLETIN 


69 


The  skin  was  moist  and  the  glandular  activity 
was  apparently  not  affected.  Her  condition  for 
several  days  following  operation  was  satisfactory, 
then  she  grew  progressively  worse  until  death. 

The  importance  of  subjecting  the  extirpated 
growth  to  a  microscopical  examination  was  illus- 
trated by  a  case  which  was  diagnosed  carcinoma 
and  on  pathological  examination  proved  to  be 
fibro-adenoma ;  another,  diagnosed  clinically 
fibro-adenoma,  was  found  to  be  undergoing  ma- 
lignancy; still  another,  diagnosed  carcinoma,  on 
microscopical  examination  showed  tuberculosis  of 
the  breast;  another  was  diagnosed  sarcoma,  and 
was  later  fi  imid  to  be  scirrhus  carcinoma  ;  another, 
diagnosed  carcinoma,  was.  in  fact,  tuberculosis  of 
the  breast :  still  another  was  diagnosed  carcinoma 
of  the  breast,  and  was  really  a  fibro-adenoma,  and 
finally  one  diagnosed  fibroma  was  found  to  be 
ai  leno-carcinoma. 

The  12  cases  occurring  in  colored  persons  were 
as  follows : 

Carcinoma  7,  aged  37,  39,  43,  47,  58,  62  and  56 
years,  respectively.  . 

Sarcoma  I.  aged  51  years. 

( ialatocele  r,  aged  25  years. 

Adeno-cystoma  1,  aged  16  years. 

Fibro-myjcoma  1,  aged  17  years. 

Tuberculosis  of  breast  1,  aged  62  years. 

The  writers  are  aware  that  they  have  not  made 
any  specially  valuable  contribution  to  medical 
knowledge  by  the  tabulation  of  these  cases.  The 
number  is  too  small,  the  records  too  meager  and 
the  pathological  investigations  too  superficial  to 
enable  us  to  do  more  than  show  the  general  char- 
acteristics of  an  unselected  series  of  100  cases. 
Of  several  facts,  however,  they  are  convinced 
from  their  own  observation,  as  well  as  from  the 
recent  literature  on  the  subject  of  mammary  tu- 
mors. (  )ne  of  these  facts  is  that  it  is  impossible 
to  know  whether  a  given  growth  is  innocent  or 
malignant  until  a  proper  microscopical  examina- 
tion has  been  made.  If  possible,  a  frozen  section 
should  be  made  by  a  competent  person  and  re- 
ported  "ii  immediately,  in  order  that  the  surgeon 
may  be  guided  as  to  the  necessity  of  performing 
a  radical  or  a  partial  operation.  When,  however, 
there  is  a  well-grounded  doubt  as  to  whether  the 
tumor  is  benign  or  otherwise,  the  patient  should 
be  given  the  benefit  of  the  doubt,  and  the  radical 
operation  should  be  performed.  Secondly,  no 
girl  or  woman  is  justified  in  keeping  a  growth  in 
her  breast,  and  this  injunction  is  the  more  imper- 


ative as  the  woman  advances  in  aye.  All  breast 
tumors  should  be  removed  in  their  incipiency;  be- 
nign tumors  may  become  malignant,  and  malig- 
nant tumors  in  a  short  time  may  become  diffused 
and  beyond  successful  and  permanent  eradica- 
tion. Thirdly,  carcinoma  probably  is  somewhat 
less  frequent  in  proportion  to  other  neoplasms 
than  is  generally  taught  ;  63  per  cent,  of  our  cases 
were  carcinomata,  but  this  is  probably  too  low 
a  percentage  for  a  normal  ratio,  and  sarcoma  oc- 
curs in  only  a  small  percentage  of  cases  (3  per 
cent,  in  this  series),  which  is  probably  more  fre- 
quent  than  is  normal. 


REMARKS  AT  THE  ANNUAL  REUNION 

OF  THE  MEDICAL  ALUMNI  ASS<  >- 

CIATK  >N,  fUNE  1,  1012. 


By  Michael  Vinciguerra,  1912. 


Professors,  Doctors  and  Fellow-Students: 

It  is  easy  to  imagine  in  what  state  of  perplexity 
I  find  myself  when  you  consider  that  I  am 
facing  at  present  not  only  my  classmates,  but 
my  illustrious  teachers,  whom  for  many  years 
I  have  been  accustomed  to  listen  to  with  great  in- 
terest and  profit. 

To  be  present  at  this  gathering  is  a  great  honor, 
and  to  stand  before  this  audience  I  consider  it 
a  great  privilege.  I  am  sure  that  on  such  an  occa- 
sion as  this  there  is  ample  room  for  an  orator  to 
be  at  his  best  in  order  to  meet  the  great  task 
before  him,  but  since  I  have  not  the  gift  of 
speech-making,  and  since  I  have  to  deal  with  a 
"foreign  tool  of  expression,"  I  trust  you  will 
pardon  me  should  I  say  less  than  what  I  feel. 

hirst  and  foremost  it  is  my  fervent  desire  to 
extend  my  thanks  to  those  who  for  many  years, 
and  day  after  day,  have  tried  to  infuse  within 
us  the  best  that  medical  science  offers — I  mean 
you.  my  most  esteemed  teachers.  It  is  my  wish 
to  impart  to  you — you,  the  delineators  of  our 
future  careers — you,  the  guides  of  our  tortuous 
and  rough  path — you,  the  stimulators  and  sources 
of  anything  that  is  of  any  good  within  us,  it 
is  to  you,  I  have  said,  that  I,  as  well  as  the  class 
of  1912,  eagerly  desire  to  extend  our  sincere 
gratitude  for  the  constant  effort  you  have  made 
during  the  past  years  to  inculcate  in  our  minds 
and  heart  the  best  of  your  vast  knowledge  and 
long  experience.  Nor  does  our  sentiment  of  ap- 
preciation toward  you  end  with  the  expiration  of 


7° 


THE   HOSPITAL   BULLETIN 


these  feeble  words  of  recognition  (I  have  said 
words  of  recognition),  for  really  I  have  no  such 
utterances  as  to  meet  this  task.  I  am  destitute  of 
any  expression  of  thanks  for  what  we  owe  you, 
and  for  this  reason  I  am  compelled  to  burv  in 
silence  most  of  our  debt  of  duty  that  by  right 
should  be  accorded  you. 

At  present  the  only  thing  that  we  have 
stored  at  the  bottom  of  our  hearts  is  our 
knowledge  of  being  ever  your  debtors.  In  this 
acknowledgment  there  is  the  signature  of  each 
and  every  student  of  the  class  of  1912  who,  while 
not  promising  you  that  we  shall  be  successful 
physicians,  do  promise  and  assure  that  we  shall 
endeavor  our  utmost  to  become  at  least  desir- 
able citizens. 

Our  actions  shall  be  ever  directed  so  as  to  give 
you  no  opportunity  of  regretting  the  time,  effort 
and  energy  that  you   have  consumed   upon   us. 

Next  in  order  I  would  like  to  thank  you,  my 
kind  classmates — ever  desirable  companions — 
faithful  and  sincere  friends  in  necessity — I  wish 
1  were  able  to  appropriately  express  to  you  my 
warmest  sentiment  of  appreciation  for  the  numer- 
ous courtesies  you  have  constantly  shown  me. 
Ever  since  the  first  time  that  I  have  had  the  for- 
tune of  meeting  you  I  have  seen  in  your  eyes  ever 
an  inviting  glance  ;  in  your  face  always  an  encour- 
aging, smile,  accompanied  with  friendly  words.  In 
case  of  necessity  I  have  found  you  constant  and 
faithful — in  case  of  action,  ready  to  act. 

But  this  is  not  all.  You  have  even  gone  a  little 
farther.  You  have  unanimously  elected  me  a 
member  of  the  "House  Committee"  and  secretary 
of  your  class.  Also  secretary  of  the  Randolph 
Winslow  Surgical  Society — positions  that  ought 
to  have  been  occupied  by  a  better  person  and  a 
more  qualified  student  than  myself.  Of  course 
all  these  pleasant  and  not  to  be  forgotten,  un- 
forgetful  events,  all  converge  toward  one  di- 
rection. 

They  conspicuously  set  forth  reflections  of 
your  kindness  toward  strangers — a  reflection 
of  your  hospitality  toward  foreigners — a  reflec- 
tion of  sacrifice  and  egotism  for  altruism — quali- 
ties that  can  be  found  only  in  a  civilized  nation 
and  among  those  students  that  are  free  from 
selfishness. 

Gentlemen,  I  owe  you  more  than  I  can  do  you 
justice  in  words.  The  time  that  I  have  spent  with 
you  shall  be  a  sweet  remembrance  of  my  future 
davs. 


I  admit  that  I  do  like  America  very  much, 
but  I  must  confess  that  I  like  you  more.  In  the 
past  I  have  been  very  happy  to  be  and  to  study 
with  you ;  at  present  I  rejoice  to  eat,  drink  and 
chat  with  all  of  you,  and  in  the  future  I  would 
be  only  too  glad  if  I  could  spend  the  rest  of 
my  days  in  your  company. 

Teachers,  classmates  and  friends,  let  me  thank 
you  at  least  once  more,  and  since  this  is  the  last 
time  that  we  shall  all  meet  together  allow  me  to  d<  1 
this  by  shaking  your  hands. 

June  1,  1912. 


The  Medical  Alumni  Association  held  its 
annual  meeting  at  the  Hotel  Caswell  on  Satur- 
day, June  1,  1912,  at  8  P.  Air  The  President, 
Dr.  Charles  E.  Sadtler,  class  of  1873,  presided. 
The  toastmaster  was  Dr.  G.  Lane  Taneyhill,  clas.s 
of  1865.  The  orator  of  the  evening,  Rev.  Lynn 
Harold  Hough,  D.  B.,  pastor  of  Mount  Vernon 
Place  Methodist  Church,  used  as  his  subject. 
''The  Measure  of  a  Man."  Professor  Arthur  M. 
Shipley,  class  of  1902,  made  a  short  address. 
Solos  were  rendered  by  Mr.  Hobart  Smock  and 
Dr.  B.  Merrill  Hopkinson,  class  of  1885.  Dr. 
Robert  Abell,  president  of  the  class,  responded 
to  the  toast  to  the  class  of  191 2. 

The  menu  was  as  follows : 

Little  Neck  Clams 

Olives  Radishes 

( uimbo  a  la  Caswell 

Bay  Shad,  Maitre  de  Hotel         Saratoga  Chips 

Crab  Flake  en  Cases 

Filet  of  Beef 

Mushrooms  Green   Peas 

Lettuce  with  Tomato  Salad 

Neapolitan   Ices 

Cafe  Noir  Cigars 

The  new  officers  for  1912-13  are:  President, 
Dr.  C.  R.  YVinterson,  class  of  1871 ;  vice-presi- 
dents, Drs.  W.  E.  Wiegand,  class  of  1876;  H.  L. 
Naylor,  class  of  1900;  W.  S.  Maxwell,  class  of 
1873 ;  recording  secretary,  Dr.  Nathan  Winslow, 
class  of  1901 ;  assistant  recording  secretary.  Dr. 
J.  C.  Macgill,  class  of  1891 ;  corresponding  sec- 
retary, Dr.  John  I.  Pennington,  class  of  1869; 
treasurer,  Dr.  John  J.  Houff,  class  of  1900.  Ex- 
ecutive committee :  Drs.  G.  Lane  Taneyhill,  class 
of  1865  ;  B.  M.  Hopkinson,  class  of  1885  ;  Geo.  A. 
Fleming,  class  of  1884;  Y.  L.  Norwood,  class  oi 
1885  ;  H.  C.  Houck,  class  of  1905. 


THE    HOSPITAL   BULLETIN  71 

TUP     HOSPITAL      BULLETIN  mer&er»  and  to  ma'<e  one  strong  and  high-class 

medical   school.     Something  must  be  done:  the 

A  Monthly  Journal  of  .Medicine  and  Surgery  unaffiliated,  unendowed   medical  school  is  an  an- 

fublished  by  aclironism,  that  cannot  much  longer  exist.     The 

THE   HOSPITAL   BULLETIN   COMPANY  Faculty  of  Physic  is  determined  that  every  per 

60S  Professional  Building  sonal  sacrifice  shall  be  made  to  comply  with  the 

Baltimore    Md  demands  of  the  times,  and  that  we  shall  have  ,1 

first-class  school  or  none. 

In  the  meanwhile  don't  forget  the  pathological 

Subscription  price,    .    .    .    $1.00  per  annum  in  advance  endowment   fund,  which  is  sadly  needing  contri- 

Reprints  furnished  at  cost.     Advertising  rate-,  buttons. 

submitted  upon  request  CONTRIBUTION    BY    CLASSES. 

1848 S50  OO 

Nathan  Winslow,  M.D.,  Editor  [868 IO  °° 

___  lS7i 35  00 

1872 70  00 

Baltimore,  Junk  15,  1912.  i873 430  00 

1874 5  °° 

THE     AMERICAN     MEDICAL     ASSOCIA-      ^75 5  °° 

TI<  )N   AND  THE  MEDICAL  COL-  „76 ' 15  °° 

LEGES.  Ic^7 IOO° 

1880 5  00 

1881 250  00 

Since  1904,  the  Council  on  Medical  Education      1882 jio  00 

has  done  a  great,  though  somewhat  arbitrary  work,      1883 35  00 

in  the  collection  and  compilation  of  facts  concern-      1885 235  00 

ing  medical  education  in  this  country ;  the  publi-      1886 100  00 

cation  of  State  Board  statistics ;  and  the  investi-      1888 50  00 

gation  and  rating  of  medical  schools.  1889 100  00 

In  1904,  there  were  166  medical  colleges  in  the      1890 175  00 

United    States.      In    the    eight    years    that   have      1892 150  00 

elapsed  since  then,  46  schools  have  gone  out  qf      1893 15  00 

existence,  and  120  are  still  in  operation.     There      1894 135  00 

has  been  a  great  advance  in  medical  education,      1895 155  00 

even  in  the  weak  schools.     An  inspection  of  the      1896 52  00 

schools   has   been    recently   completed,   and   they      1897 80  00 

have  been  rated  in  accordance  with  this  investi-      1898 105  00 

gation.     While  injustice  may  have  been  done  to      1899 25  00 

some,  there  can  be  no  doubt  as  to  the  general      1900 215  00 

accuracy  of  the  ratings.    There  are  still  too  many      1901 185  00 

medical  colleges,  and  it  is  the  avowed  purpose  of      1902 305  00 

the  American  Medical  Association  to  compel  the      1903 300  00 

merging  or  extinction  of  schools  until  there  shall      1904 145  00 

not  be  more  than  70  left.     These  must  be  thor-      1905 200  00 

oughly   equipped    for   the    proper  instruction    of      1906 155  00 

students  in  medicine.     It  will  be  a  matter  of  the      1907 no  00 

survival  of  the  fittest.     The  Council  is  exerting      1909 5  00 

pressure  to  compel  the  merging  of  the  University      19 10 50  00 

of  Maryland,  College  of  Physicians  and  Surgeons,      191 1   Terra  Mariae 3  5° 

and  Baltimore  Medical  College,  into  one  institu-      1912  Club  Latino  Americano 25  00 

tion,  and  the  closing  of  other  weaker  schools.    An  

effort    is    now    being    made    to    accomplish    this  Total  subscriptions  to  June  1.   [912.. $9956  5° 


72 


THE    HOSPITAL    BULLETIN 


XEW    SUBSCRIPTIONS    IN     MAY. 

Dr.  W.  Ward  Olive,  1906 $25  00 

Dr.  Marshall  B.  West.  1901 10  00 

Frank  P.  Marsden,  Esq 10  00 

E.  A.  &  B.  M.  Watts 10  00 

J.  J.  Landragan,  Esq 5  00 

Cash 1  00 

Additions   for  the  month $61   00 


THE   ONE   HUNDRED   AND   FIFTH   AN- 
NUAL COMMENCEMENT. 


The  annual  commencement  of  the  University 
of  Maryland  was  held  at  the  Lyric,  Saturday 
afternoon,  June  1,  1912,  at  4  o'clock.  The  order 
of  exercises  was  as  follows: 

Overture — "Raymond" A.  Thomas 

Selection — "Quaker  Girl" Caryl 

Waltz — "Enchantress" Victor  Herbert 

1.  Music — March,  "Tannhauser" R.  Wagner 

2.  Prayer  by  Rev.  Thomas  Grier  Koontz. 

3.  Music — Song.  "Rosary" E.  Nevin 

4.  Address  to  the  Graduates.  Edgar  H.  Gans,  LL.D. 

5.  Music — "U.  S.  Patrol" Thomas 

6.  Conferring  of  Degrees  by  the  Provost  of  the  Uni- 

\  ersity. 

Candidates  for  the  Degrees  "Bachelor  of  Arts"  and 
"Bachelor  of  Sciences"  presented  by  the  Dean 
of  the  Faculty  of  Arts  and  Sciences. 

Candidates  for  the  Degree  "Doctor  of  Medicine" 
presented  by  the  Dean  of  the  Faculty  of  Physic. 

Candidates  for  the  Degree  "Bachelor  of  Laws"  pre- 
sented by  the  Dean  of  the  Faculty  of  Law. 

Candidates  for  the  Degree  "Doctor  of  Dental  Sur- 
gery" presented  by  the  Dean  of  the  Faculty  of 
Dentistry. 

Candidates  for  the  Degree  "Doctor  of  Pharmacy" 
presented  by  the  Dean  of  the  Faculty  of  Phar- 
macy. 

7.  Conferring  of  Honorary  Degrees. 

8.  Music — "Chanson  Sans  Paroles" Tchaikowsky 

9.  Award  of   Prizes. 

10.     Music — March,  "Lorraine" Ganne 

L   II.  Fisher,  Director  of  Orchestra. 

There  were  22S  graduates.  They  were  pre- 
sented  by  the  deans  of  their  respective  depart- 
ments, and  were  classified  as  follows: 

Bachelor  of  Arts 16 

Bachelor  of   Science 3 

DoctO?  of   Medicine 75 

Rachelor  of  Laws 50 

Doctor  of  Dental  Surgery 50, 

D01    ir  of  Pharmacy -jz 


Students  who  received  degrees  are : 

Bac  helor  or  Arts. 

Edgar  Stanley  Bowlus. 
John  Arthur  Brashears. 
Clarence  Leewood  Dickinson. 
Charles  Griffith   Haslup. 
Herman  Richard  Holljes. 
Robert  Spencer  Hopkins. 
Spencer  Drummond  Hopkins. 
Wilhelm  Lcntz. 
Benjamin  Michaelson. 
Frederick  Appel  Miller. 
Louis  Earnest   Payne. 
Charles  Holland  Riggin. 
Raymond  Staley. 
Arthur  Everett  William- 
George  Leiper  Winslow. 
Samuel  Rowland  White.  Jr. 

B  H  Illl.ou   OF    SCIENCE: 
Philip  Langdon  Alger. 
William  John  Jones. 
Kenneth  Edgar  Wilson. 

Doctor  or  Medicine. 
Robert  Ephraim  Abell.  South  Carolina. 
Reese  Alexander  Allgood.  South  Carolina. 
Robert  Glenn  Allison,  South  Carolina. 
Angel  Virgilio  Aviles,  Ecuador,  S.  A. 
George  Cullen  Battle,  North  Carolina. 
Grover  Cleveland  Beard.  North  Carolina. 
Bernard   Mark  Berngarlt.   Mankind. 
Harry  Aloysius  Bishop.  District  of  Columbia. 
Robert  Alexander  Bonner,  Maryland. 
Sidney  Eli  Buchanan,  North  Carolina. 
William  Thomas  Chipman,  Delaware. 
Charles  Peter  Clautice,  Maryland. 
Wilfred  Rivers  Claytor,  South  Carolina. 
James  Daniel  Cochran,  North  Carolina. 
Thomas  Joseph  Conners,  Connecticut. 
John  Dade  Darby.  Maryland. 
Russell  Hardy  Dean,  Jr.,  Florida. 
Harry  Deibel,  Maryland. 
John  Bernard  Donovan,  Maine. 
James  Archie  Duggan.  Georgia. 
John  William  Ebert,  Virginia. 
Ernest  William  Frcy,  Maryland. 
William  Edwin  Gallion,  Jr..  Maryland. 
Dawson  O.  George.  Maryland. 
Abraham  Goldstein,  New  York. 
William   Granville   Haines.  Maryland. 
Judson  E.  Hair.  South  Carolina. 
Edward  II.  J.  Hennessey.  Connecticut. 
Milford  Hinnant,  North  Carolina. 
James  Edward  Hubbard,  Maryland. 
Henderson    Irwin,  North   Carolina. 
Edward  S003  Johnson,  Maryland. 
John  Kent  Johnston,  Florida. 
Charles   Luring  Joslin.   Maryland. 
M.  Randolph  Kalm,  Maryland. 
Edwin  Paul  Kolb,  Maryland. 
Daniel  Henry  Lawler,  Connecticut. 


THE    HOSPITAL    BULLETIN 


/5 


Simmi  Geilech  Lenzner,  Now  York. 

Moses  Louis  Lichtenberg,  Maryland. 

Bertrand  Allen  Lillich,  Pennsylvania. 

liverett     Alexander   Livingston,   North   Carolina. 

Enrique  Llamas.  Colombia,  S.  A. 

Edward    Vnderson  Looper,  Georgia. 

Benjamin  J.  McGoogan,  North  Carolina. 

Andres  Martin  G.  de  Pcralta,  Cuba. 

William  Michel,  Maryland. 

Benjamin  Newhouse,  Maryland. 

John  Charles  Norton,  Maryland. 

Roger  Vinton  Parlett,  Maryland. 

Robert  Bruce  Patrick,  South  Carolina. 

Philip  Pearlstein,  Texas. 

Charles  \Vm.  Rauschenbach,  Maryland. 

Harry  Herman  Rich,  New  Jersey. 

Joseph  Rottenberg,  Maryland. 

Wilbur  Moate  Scott,  Georgia. 

Jay  I ).  Sharp,  Indiana. 

Everett  Alanson  Sherrell,  North  Carolina. 

David  Silberman,  Maryland. 

John  Andrew  Skladowsky,  Maryland. 

Clarke  Jackson  Stallworth,  Alabama. 

John  Clinton  Stansbury,  Maryland. 

Grover  A.  Stem.  Man  land. 

Thomas   F.   A.  Stevens,   Maryland. 

Jesse  Cunningham  Stilley,  Pennsylvania. 

Edward  Charles  Straessley,  Pennsylvania. 

William  C.  Terry,  North  Carolina. 

John  Henry  Traband.  Jr.,  Maryland. 

Gerardo  Vega  y  Thomas,  Cuba. 

Michael  Vinciguerra,  New  Jersey. 

Harold  Homer  Webb,  Virginia. 

Edwin  V.  Whitaker,  Louisiana. 

Hyman   R.  Wiener,  Pennsylvania. 

Robert  Cleveland  Williams,  North  Carolina. 

W.  Howard  Veager,  Pennsylvania. 

Henn   Zimmerman.  Massachusetts. 


University 


prize. 


Prizeman'. 
gold  medal,   Charles   William 


Rauschenbach. 


Certificates  of  Honor. 
Edwin  Paul  Kolb,  William  Granville  Haines, 

Robert  Ephraim  Abell,  Robert  Alexander  Bonner, 

William  Michel. 

Bachelor  of  Laws. 

Benjamin  Baker.  Horace  Edgar  Flack, 


Joseph  Allien  Baker, 
Charles  William  Bald, 
Lewin  Wethered  Barroll, 
Robert  Dixon  Bartlett, 
Levin  Creston  Beauchamp, 


William  Earl  Fraley, 
Llarry  Walter  Ganster, 
Lawrence  Wolf  Goldheim. 
John  Biddison  Gout  rum. 
Homer  Ewing  Holt, 


1  [yman  Nathaniel  Blaustein,  Edward  Everett  Johnston, 


Ubert  Page  Boyce, 
Karl  Edw.  Meikle  Hubert. 
Raymond  Herman  Bubert, 
Francis  James  Carey, 
Malcolm  Joseph  Coan, 
Henry  Doeller,  Jr., 
Allan  Herbert  Fisher, 


Josiah  Purnell  Johnson, 
William  Leigh,  Jr., 
Lewis  Rudolph  Lemke. 
Harry  Oscar  Levin, 
William  Penn  Lewis,  Jr., 
George  Wash.  Lindsay, 
James  Russell  Manning, 


Nathaniel  Thos.  Meginnis, 
Louis  Mitnick, 
Carl  Gage  Mullin. 
Albert  Graham  <  Iber,  Jr., 
William  Allen  Owings, 
Frank  Robert  Paterson, 
Philip  Benjamin  l'erlman, 
Samuel  Benjamin  Plotkin, 
Virtume  P.  Alphonse  Quinn, 
Alfred  Nicholas  Reichert, 
Richard  Hynson  Rogers, 


Ernest  Ruediger, 
Charles  George  Sehrt, 
Everard  Pattison  Smith. 
Thos.  Alexander  Smith,  Jr., 
Clarence  Edward  Steer, 
John  Samuel  Turner.  Jr., 
George  Ross  Veazey, 
Samuel  Woodson  Venable, 
Edward  Philip  Waldschmidt, 
George  Schubert  Weikart. 
David   Angle   Wolfinger. 


Doctor  op  Dental  Surgerv. 
Leslie  Talmage   Allen,  Canada. 
William  Lurty  Baugher,  Virginia. 
Don  Allen  Bernhardt,  West  Virginia. 
Harry  William  Binder.  Maryland. 
John  Aloysius  Black,  New  Jersey. 
Paul  Hewitt  Blanchard,  Vermont. 
David  F.  Blatt.  Maryland. 
William  Henry  Bond,  Georgia. 
Harold  Ellsworth   Bonney,  Virginia. 
Aubrey  Hopper  Burk,  New  Jersey. 
John  Osborne  Camp,  Connecticut. 
Walter  Herbert  Clark,  New  Hampshire. 
Roy  Ben  Dawson,  West  Virginia. 
Luke  William  Delaney,  New  Jersey. 
Robert  Henry  Ellington,  North  Carolina. 
Francis  John  Ellison,   Maryland. 
Henry  Edward  Fitzpatrick,  New  Hampshire. 
Dawson  Young  Flook,  Maryland. 
Arthur  Clay  Foard,  Maryland. 
Isaac  I.  Ganzburg,  Connecticut. 
Herbert  Thomas  Grcmpler,  Maryland. 
Joseph  John  Hamlin,  North  Carolina. 
J.  Francis  Healey,  New  York. 
Frank  Trump  Herr,  Maryland. 
Robert  Lee  Hicks,  South  Carolina. 
Thomas  Halliday  Hoffman,  Pennsylvania. 
David   Thomas   Borthwick  Llouston,   New  Jersey. 
Hamilton  Jefferson,  Georgia. 

John  Frederick   Marshall  Keighley,  Rhode   Island. 
Frederick  Leo  Kenna,  New  Jersey. 
Walter  Scott  Kennedy,  New'York. 
George  Earle  Kirschner,  Pennsylvania. 
William  Llewellyn  Lloyd.  Maryland. 
John  Alexander  McClung.  Virginia. 
Joseph  Maurice  Mansir.   Maine. 
Alfred  Eugene  Martin,  New  Jersey. 
Curtis  Whitney  Merrill,  Rhode  Island. 
Frederick  Olmsted  Moore,  Vermont. 
Miguel  Montesinos,  Porto  Rico. 
Henry  Forman  Ortel,  Maryland. 
Lawrence  Randolph  Outten,  Delaware. 
George  Kernodle  Patterson,  North  Carolina. 
Berkeley  Miller  Pemberton,  Virginia. 
Ralph  Ray,  North  Carolina. 
John  L.  Remsen.  New  Jersey. 
Paul  Salles,  Louisiana. 
Carl  Edward  Schlieder,  New    York. 
Elton  Ashbv  Sims,  Maryland. 


74 


THE   HOSPITAL   BULLETIN 


Albert  James   Sinay,  Connecticut. 
Meyer  Everett  Sinskey,  Maryland. 
Wylie  Isaac  Smith,  New  Jersey. 
Minot  Benton  Stannard,  New  Jersey. 
Joseph  B.  Steinberg,  Maryland. 
Henry  Streich,  Maryland. 
James  J.  Sullivan,  New  Hampshire. 
Herbert  Ambrose  Thrift,  Rhode  Island. 
Norman  Charles  Thurlow,  Maine. 
Carlos  A.  Walker,  Maryland. 
Owings  C.  Woods,  South  Carolina. 

Prizeman. 
University  prize,  gold  medal,  Leslie  Talmage  Allen. 

Honorable  Mention. 
Thomas   Halliday   Hoffman. 

Doctor  of  Pharmacy. 

Hugh  Kelly  Borland,  Maine. 

Sidney  Joseph  Brown,  Florida. 

Benjamin  Bruce  Brumbaugh,  Maryland. 

Clarence  A.  Davis,  South  Carolina. 

Hermann  Dietel,  Jr.,  Texas. 

Ethan  Oglivie  Frierson,  South  Carolina. 

Harry  Sherman  Harrison,  Maryland. 

Henry  Felix  Hein,  Texas. 

Lee  Hodges,  South  Carolina. 

Dennis  Paul  Lillich,  Pennsylvania. 

George  Lucius  McCarty,  Virginia. 

John  Gordon  Mclndoe,  Maryland. 

Charles  Edwin  McCormick,  Maryland. 

Frederick  Minder,  Maryland. 

Carrie  G.  Mossop,  Maryland. 

Robert  Reginald  Pierce,  Maryland. 

Lloyd  Nicholas  Richardson,  Maryland. 

Joaquina  Ruiz  de  Porras,  Porto  Rico. 

Thomas  Stanley  Smith,  Virginia. 

John  Alfred  Strevig,  Pennsylvania. 

Harold  A.  Swartz,  Maryland. 

Randall  Cholmondeley  Ward,  West  Virginia. 

Daniel  Andrew  Warren,  Maryland. 

James  J.  Wolfe,  Maryland. 

John  Stanley  Yakel.  Maryland. 

Prizeman. 
Gold  medal  for  general  excellence,  Hermann  Dietel,  Jr. 

Certificates  of  Honor  in  Order  of  Merit. 

Lee  Hodges, 
Henry  Felix  Hein, 
Sidney  Joseph  Brown. 

Special  Prizes. 

Simon   medal   for   superior   work   in   chemistry.   Her- 
mann Dietel.  Jr. 

Junior   Class — Horordble   Mention    in    Order   of   Merit. 

B.  Olive  Cole, 
James  W.  Watkins, 
Thomas  A.  Crowcll. 


ABSTRACT 


TECHNIC  OF  RESECTION  OF  RIB  UNDER 
LOCAL  ANESTHESIA. 

At  the  recent  meeting  of  the  Medical  and 
Chirurgical  Faculty  of  Maryland  Dr.  Charles 
Bagley,  Jr.,  class  of  1904,  in  a  paper  on  the  tech- 
nic  of  resection  of  rib  under  local  anesthesia,  had 
the  following  to  say  (Journal  A.  M.  A.,  May 
18.  1912) : 

Dr.  Charles  Bagley,  Jr.,  Baltimore. — "General 
anesthesia  does  not  seem  to  be  altogether  safe. 
The  lung,  which  has  perhaps  been  the  seat  of 
pneumonia,  is  now  mechanically  compressed  by 
the  accumulation  of  pus  in  the  pleural  cavity.  In 
addition,  air  is  allowed  to  enter  the  cavity  during 
operation  as  the  pus  escapes,  possibly  causing 
serious  difficulty.  Local  anesthesia,  if  it  can  be 
successfully  produced,  seems  to  be  the  proper 
method  of  protecting  these  patients  against  the 
severe  pain  of  the  operation.  The  patient  is 
placed  on  the  side  opposite  the  disease.  The 
field  of  the  operation  is  prepared  either  in  the 
usual  manner  or  by  the  iodin  method.  The  eighth 
rib  is  selected  and  the  area  infiltrated  with 
Schleich's  solution,  beginning  just  to  the  inner 
side  of  the  apex  of  the  scapula  and  then  extend- 
ing three  inches  outward  in  the  direction  of  the 
rib,  care  being  taken  to  inject  this  solution  into 
the  true  skin.  An  incision  is  then  made  from 
within  a  half  inch  of  the  outer  extremity.  The 
fibers  of  the  latissimus  dorsi  muscle  are  now 
exposed  and  infiltrated  with  the  solution,  then 
divided.  On  retraction  the  periosteum  will  be 
exposed  and  may  be  anesthetized  by  vigorously 
rubbing  in  powdered  cocain  on  an  applicator,  or 
injecting  Schleich's  solution  under  the  surface, 
both  methods  seeming  to  act  well.  An  incision 
is  then  made  in  the  periosteum  in  the  direction 
of  the  rib,  an  inch  and  a  half  long,  and  midway 
between  the  upper  and  lower  border.  From 
either  end  of  the  incision  a  cross-incision  is  made, 
extending  from  the  upper  to  the  lower  border  of 
the  rib  entirely  through  the  periosteum.  A 
periosteal  flap  is  then  formed  above  and  below 
and  is  dissected  from  the  outer  surface  of  the 
rib.  A  pledget  of  cotton  in  a  small  mosquito  for- 
ceps is  dipped  into  the  powdered  cocain  and  the 
exposed  surface  of  the  rib  vigorously  rubbed  until 
it  is  insensible  to  pain.  Care  must  be  taken  that 
the  wound  is  dry  in  order  that  blood  and  serum 


THE   HOSPITAL   BULLETIN 


75 


may  not  cause  the  cocain  to  flow  along  the  lower 
portion  of  the  wound  and  be  absorbed.  When  the 
rib  is  partially  cocainized  the  separation  of  the 
periosteum  is  again  undertaken  with  a  periosteum 
elevator.  After  final  cocainization,  the  bone  is 
divided  by  Liston's  forceps,  only  the  point  of  the 
blade  being  used,  the  instrument  being  held  in 
a  vertical  position.  When  about  one  inch  of  the 
bone  is  removed  a  glistening  surface  is  seen 
underneath.  This  is  injected  with  Schleich's  solu- 
tion and  an  incision  as  large  as  desired  made  in 
the  direction  of  the  rib.  Drainage-tubes  are  in- 
serted anil  a  couple  of  tucks  of  gauze  placed  at 
the  angle  of  the  wound,  all  secured  by  a  safety- 
pin.  Sutures  are  omitted — to  save  time  and  be- 
cause of  the  importance  of  securing"  primary 
union  in  the  presence  of  infection." 


ITEMS 

Dr.  Raymond  Garrison  Hussey,  class  of  191 1, 
who  has  been  resident  physician  at  the  tubercu- 
losis hospital  at  Bayview,  has  resigned  to  accept 
a  like  position  at  the  State  Sanatorium,  Sabillas- 
ville,  Md. 


Dr.  Norman  Thomas  Kirk,  class  of  1910,  has 
passed  the  Army  examinations  and  will  receive 
his  commission  in  the  United  States  Medical 
Reserve  Corps  (active)  as  First  Lieutenant  July 
1,  1912. 


Miss  Florence  V.  King,  class  of  1910,  Uni- 
versity Hospital  Training  School  for  Nurses,  has 
charge  of  St.  Luke's  Hospital,  Fayetteville,  N.  C. 


Miss  Mattie  Estelle  Coale,  class  of  1912,  Uni- 
versity Hospital  Training  School  for  Nurses,  will 
engage  in  district  nursing  here  in  Baltimore. 


The  following  appointments  at  the  University 
Hospital  for  the  coming  year  have  been  an- 
nounced : 

Assistant  resident  surgeons :  Dr.  FitzRan- 
dolph  Winslow,  class  of  1906;  Drs.  Robert 
E.  Abell,  William  E.  Gallion,  Edward  E.  Looper 
and  Henderson  Irwin,  all  of  the  class  of  1912. 
Assistant  resident  physicians:  Drs.  Charles  W. 
Rauschenbach,  Reese  A.  Allgood,  William  M. 
Scott  and  Judson  E.  Hair,  class  of  1912.  Resi- 
dents at  the  maternity  hospital :  Drs.  Louis  Har- 
riman  Douglass,  class  of  191 1.  John  D.  Darby 
and  William  Michell,  class  of  1912.  Assistant  resi- 


dent gynecologists:  Drs.  William  L.  Byerly  and 
Louis  Kyle  Walker,  both  of  the  class  of  191 1. 
Resident  pathologist:  Dr.  Moses  L.  Lichtenberg, 

class  of  '912,  and  alternate,  Dr.  Robert  A.  Bon- 
ner, class  of  1912. 


The  following  alumni  have  died  during  the 
year : 

Robert  Atkinson,  class  '54,  died  at  Baltimore 
May  22,  aged  79. 

Norman  F.  Hill,  class  '82,  died  at  Baltimore 
May   13,  aged  61. 

Jno.  R.  T.  Reeves,  class  '58,  died  at  Cbaptin. 
Md..  April  14,  aged  79. 

Richard  Sappington,  class  '51,  died  at  Balti- 
more, Md.,  May  14,  aged  84. 

Stephen  H.  Griffith,  class  '90,  died  at  Gaffhey, 
S.  C,  May '13,  aged  44- 

Thos.  H.  Beltz,  class  '63,  died  at  York,  Pa., 
May  1 1 ,  aged  69. 

Edwin  G.  Darling,  class  '82,  died  at  Laura- 
ville,  Md.,  June  6,  aged  52. 

G.  E.  Milton  Smith,  class  '88,  died  at  Balti- 
more, Md.,  May  22,  aged  43. 

Van  E.  De  Lashmott,  class  '54,  died  at  Shel- 
burn,  Ind.,  May  25,  aged  79. 

Robt.  H.  Gantt,  class  '09,  died  at  Fort  Sam 
Houston,  Tex.,  June  10,  aged  27. 

Win.  Worthington  Hopkins,  class  '58,  died  at 
Havre  de  Grace,  Md.,  August  4,  aged  74. 

Geo.  W.  Truitt,  class  '75,  died  at  Baltimore, 
.Md.,  July  11,  age  65. 

Joel  W.  Nixon,  class  '78,  died  at  St.  Louis, 
Mo.,  August  25,  aged  62. 

Luther  M.  Zimmerman,  class  '64,  died  at 
Woodsboro,  Md.,  September  13,  aged  71. 

Jos.  Penn  Chaney,  class  '52,  died  at  Breatheds- 
ville,  Md.,  October  3,  aged  81. 

Lawrence  Sterling  Alexander,  class  "(>8,  died 
at  St.  Augustine,  Fla.,  November  6,  aged  68. 

Jno.  Reese  Uhler,  class  '61,  died  at  Baltimore, 
Md.,  October  9,  aged  72. 

Napoleon  B.  Nevitt,  class  '57,  died  at  Accotink. 
Va.,  September  25,  aged  81. 

Oliver  J.  Gray,  class  '02,  died  at  Wilmington, 
Del.,  September  29,  aged  31. 

Geo.  Edward  Gilpin,  class  '82,  died  at  Berkeley 
Springs,  W.  Va.,  November  3,  aged  65. 

Harry  V.  Harbaugh,  class  '07,  died  at  Cam- 
bridge. Md.,  November  10,  aged  28. 

Andrew  C.  Dukes,  class  '71,  died  at  Columbia. 
S.  C,  November  30,  aged  61. 


THE    HOSPITAL    BULLETIN 


Wm.  E.  Gaver,  class  '88.  died  at  Mt.  Airy. 
Md.,  December  31.  aged  48. 

1  'ierre  G.  Dausch,  class  '68,  died  at  Baltimore, 
Md.,  November  26,  aged  65. 

Summerfield  Berry  Bond,  class  '83,  died  at 
Baltimore,  Md.,  December  21,  aged  50. 

Wm.  F.  Hengst.  class  'j6,  died  at  Baltimore. 
Md.,  December  4,  aged  57. 

Benj.  F.  Price,  class  '$'.  died  at  Mt.  Carmel, 
Md.,  December  15.  aged  76. 

Jos.  V.  Milton,  class  '01,  died  at  Lacy  Springs, 
Ya..  December   16,   aged  35. 

Wm.  C.  P.  Boone,  class  '72,  died  at  Baltimore, 
Md.,  December  30.  aged  (17. 

Enoch  George,  class  '72.  died  at  Denton.  Md., 
January  12,  aged  61. 

Louis  W.  Morris,  class  '85.  died  at  Salisbury, 
Md.,  February  2,  aged  46. 

1  lilbert  C.  Greenway,  class  '68,  died  at  Hot 
Springs.  Ark.,  January  19,  aged  71. 

Norton  R.  Hotchkiss,  class  '91,  died  at  New 
Haven.  Conn.,  January  30.  aged  41. 

Mathias  A.  K.  Borck,  class  '63,  died  at  St. 
Louis.  Mo.,  January  20,  aged  ~~. 

Harry  B.  Gantt,  class  '80.  died  at  Baltimore, 
Md.,  January  20,  aged  54. 

John  L,  Blair,  class  '68,  died  at  Mercersburg, 
Pa.,  December  31,  aged  66. 

Jos.  L.  Muncey,  class  '91,  died  at  Penhook, 
Ya.,  December  29.  aged  45. 

Nathan  D.  Tobey,  class  '63,  died  at  Vaughn, 
N.  M.,  January  19,  aged  74. 

Peter  H.  Lathan,  class  '76,  died  nt  Wetherly, 
Pa.,  January  23.  aged  62. 

Julius  Levin,  class  '05,  died  at  Johnstown,  Pa., 
February   12,  aged  32. 

Geo.  E.  H.  Harmon,  class  'jz.  died  at  Cam- 
bridge, Md.,  March  5,  aged  64. 

Thos.  Robert  Dougher,  class  '09.  died  at 
Avoca,  Pa.,  February  16,  aged  2~. 

Daniel  Thos.  Bowden,  class  '89,  died  at  Pat- 
terson. N.  J.,  March  18,  aged  46. 

William  T.  Arnold,  class  '~^,  died  at  Balti- 
more, Md.,  March  31,  aged  67. 

Jno.  Evans  Mackall,  class  '08,  died  at  Elkton, 
Md.,  April  4,  aged  2<>. 

Floyd  W.  Rogers,  class  '02.  died  at  Newport, 
R.   I..   March  26,  aged   52. 

Wm.  II.  Feddeman,  class  '88,  died  at  Balti- 
more, Md..  April  12,  aged  46. 

Louis  AY  Crampton,  class  '69,  died  at  San 
Bernardino,  Cal.,  April  12,  aged  63. 


Wm.  A.  Henchman,  class  'j^,.  died  at  Mc- 
Keesport,  Pa.,  April  19,  aged  63. 

John  W.  Fields,  class  '60,  died  at  Chincoteague 
Island,  Ya.,  May  4,  aged  75. 

Ephraim  Hopkins,  class  '59,  died  at  Darling- 
ton, Md.,  May  n,  aged  75. 

J.  R.  Bromwell,  class  '71,  died  at  Washington, 
D.  C,  May  25,  aged  70. 

H.  E.  Bowman,  class  '39,  died  at  Farming- 
ton.  Iowa,  April  29,  aged  93. 


(Continued  From  May  Number.) 

Among  the  University  alumni  and  professors 
whose  sketches  appear  in  Dr.  Kelly's  Cyclopedia 
of  American  Medical  Biography  are  : 

John  Fonerden,  class  of  1823,  whose  friendship 
with  Johns  Hopkins  probably  furnished  the 
motive  for  the  founding  of  the  Johns  Hopkins 
Hospital. 

Charles  Frick,  class  of  1845,  and  professor  of 
materia  medica  and  therapeutics  in  the  University, 
in  whose  honor  the  Frick  Library  of  the  Medical 
and  Chirurgical  Faculty  of  Maryland  is  founded. 

Aaron  Friedenwald.  class  of  i860,  president 
of  the  Medical  and  Chirurgical  Faculty  of  Mary- 
land. 1889. 

Eli  Geddings,  professor  of  anatomy  and  physi- 
ology in  the  University  from  1851  to  1857. 

John  D.  Godman,  class  of  1818,  the  anatomist. 

Horace  H.  Ilayden,  who  received  the  honorary 
degree  of  M.D.  at  the  University  in  1840,  founder 
of  the  Baltimore  College  of  Dental  Surgery. 

William  Travis  Howard,  professor  of  physi- 
ology in  the  University  of  Maryland,  1866;  pro- 
fessor of  diseases  of  women  and  children,  1867, 
and  becoming  emeritus  professor  1897,  Univer- 
sity, LL.D.,  1907. 

Horatio  Gates  Jameson,  class  of  1813,  one  of 
the  founders  of  the  Washington  Medical  College 
and  later  president  Ohio  Medical  College,  editor 
Maryland  Medical  Recorder,  and  who  preceded 
Lord  Lister  in  antiseptic  surgical  work. 

Christopher  Johnston,  class  of  1844,  founder 
Maryland  Medical  Institute,  professor  anatomy 
and  physiology  in  the  University  from  1864  to 
1869,  and  professor  of  surgery  from  1869  to  i88r, 
died  1891.    ( )ne  of  Maryland's  greatest  surgeons. 

Thomas  Sargent  Latimer,  class  of  i8(n. 
surgeon  in  the  Confederate  Army,  editor  Balti- 
more Medical  Journal,  and  for  many  years  presi- 
dent of  the  College  of  Physicians  and  Surgeons. 


THE    HOSPITAL    BULLETIN 


77 


( leorge  Warner  Miltenberger,  class  of  1840, 
■  lean  of  the  University  faculty,  and  professor  of 
obstetrics,  professor  of  therapeutics  and  materia 
medica,  professor  emeritus  and  honorary  presi- 
dent of  the  Faculty,  after  spending  over  half  a 
century  in  the  service  of  the  University. 

Robert  Brown  Morrison,  class  of  1874,  clinical 
professor  of  dermatology  in  the  University,  and 
pioneer  dermatologist  of  Maryland. 

Russell  Murdock,  lecturer  on  diseases  of  the 
eye  and  ear  in  the  University,  1868-69. 

James  Croxall  Palmer,  class  of  1834,  later 
surgeon-general  United  States  Navy,  served  in 
Mexican  and  Civil  Wars,  died  1883. 

John  Williamson  Palmer,  class  of  1846,  first 
city  surgeon  of  San  Francisco,  a  writer  of  note 
and  one  of  the  editors  of  the  Century  and  Stand- 
ard dictionaries. 

( iranville  Sharp  Pattison.  appointed  to  the 
chair  of  anatomy,  physiology  and  surgery  in  the 
University  of  Maryland  in  1820,  and  who  enjoyed 
a  high  reputation  as  an  anatomical  teacher. 

Nathaniel  Potter,  first  professor  of  principles 
and  practice  of  medicine  in  the  University,  and 
holding  this  position  until  his  death  in  1843. 

William  Power,  class  of  1835,  lecturer  in  1841 
at  University  Hospital,  giving  two  remarkable 
lectures  on  exploration  of  the  chest,  successor  of 
Elisha  Bartlett,  a  great  clinical  teacher. 

Joseph  Roby,  professor  anatomy  and  physii  '1'  >gy 
in  the  University,  1842. 

George  Henry  Rohe,  class  of  1873,  organizer 
of  Springfield  Hospital. 

Irving  Collins  Rosse,  class  of  1866,  army 
surgeon. 

Moses  John  DeRossett,  adjunct  to  the  professor 
of  chemistry  in  the  University  and  professor  of 
chemistry  in  the  Dental  School. 

Nathan  Ryno  Smith,  professor  of  surgery  in 
the  University,  1827. 

David  Stewart,  class  of  1844,  lecturer  in  the 
University  on  pharmacy,  first  independent  pro- 
fessor of  pharmacy  in  the  United  States. 

Charles  Alexander  Warfield,  president  of  the 
University  in  1812-13. 

John  Doane  Wells,  professor  of  anatomy  and 
surgery  in  the  University  from  1829  to  his  death 
in  August,  1830. 

Thomas  Henry  Williams,  class  of  1849,  as- 
sistant surgeon  in  the  United  States  Army,  and 
afterwards  surgeon  in  the  Confederate  Army. 


Henry  Parke  Custis  Wilson,  class  of  185 1.  prac- 
tically the  founder  of  gynecology  in  Maryland, 
died   1897. 

Caleb  Winslow,  father  of  Drs.  Randolph  and 

John  R.  Winslow,  and  grandfather  of  Drs.  Na- 
than and  FitzRandolph  Winslow. 

William  Maxwell  Wood,  class  of  1829,  native 
of  Harford  County,  Md.,  army  surgeon  during 
Seminole,  Mexican,  Chinese  and  Civil  wars, 
surgeon  on  Minnesota  at  time  of  battle  between 
Monitor  and  Merrimac. 

William  Zollickhoffer,  class  of  1818,  botanist. 


Among  the  medical  men  who  attended  the 
smoker  of  the  General  Alumni  Association  on 
May  31  at  the  Hall  of  the  Medical  and  Chirurgi- 
cal  Faculty  were  Drs.  Charles  E.  Sadtler,  Ran- 
dolph Winslow,  Nathan  Winslow,  Eugene  F. 
Cordell,  J.  M.  Hundley.  C.  F.  Nplen,  B.  M.  Hop- 
kinson,  T.  A.  Ashby,  C.  R.  Winterson,  J.  W. 
Holland,  F  II.  Davis.  L.  1'..  Henkel.  Jr..  John  C. 
llemmeter,  H.  M.  Robinson,  and  the  following 
members  of  the  graduating  class:  George  E. 
Bennett,  Bernard  M.  Berngartt,  Grover  C.  Beard, 
I  leorge  Cullen  Battle,  Charles  P.  Clautice,  W. 
Thomas  Chipman,  Thomas  Joseph  Connors,  John 
Bernard  Donovan.  John  Dade  Darby,  Harry 
Deibel,  James  Archie  Duggan,  John  W.  Ebert, 
Ernest  William  Frey.  William  Granville  Haines, 
Edward  Sooy  Johnson.  Everett  A.  Livingston, 
Bertrand  Alley  Lillich,  Gerard  Henry  Lebret, 
Benjamin  J.  McGoogan,  Andres  ( i.  Martin,  Phil- 
lip Pearlstein,  Joseph  Rottenberg,  1  irover  A. 
Stem,  John  A.  Skladowsky,  John  C.  Stansbury, 
W.  C.  Terry,  John  Henry  Traband.  Jr.,  Michael 
Yinciguerra,  Harold  Hamer  Webb.  R.  C.  Wil- 
liams. The  attendance  at  the  banquet  was  as 
follows  : 

Alumni,  guests,  newspaper  representatives,  4''; 
medical  graduates,  29;  dental  graduates.  14: 
pharmacy  graduates,  21  ;  academic  graduate-;.  12: 
unclassified,  18. 


Drs.  Thomas  Gay  Whims,  class  of  1911,  of 
Lasker,  N.  C. ;  Samuel  J.  King,  class  of  1903. 
formerly  of  Grand  Junction,  Col.,  but  now  located 
at  Zanesville,  Ohio ;  William  V.  Parramore,  class 
of  1910,  of  the  Georgia  State  Sanatorium;  Morris 
Ramsey  Bowie,  class  of  1908,  of  Somerset,  Col. ; 
Guy  Philip  Asper,  class  of  1903,  of  Chambers- 


78 


THE    HOSPITAL    BULLETIN 


burg,  Pa. ;  Charles  R.  Richardson,  class  of  1903, 
of  Belair,  Md.,  and  John  Nelson  Neill  Osburn, 
class  of  1909,  of  Martinsburg,  W.  Va.,  were 
among  the  recent  visitors  to  the  University 
Hospital. 


At  the  one  hundredth  commencement  of  the 
I  Iniversity  and  the  one  hundred  and  fifth  of  the 
medical  school,  honorary  degrees  were  conferred 
as  follows :  Rev.  Thomas  Grier  Koontz,  Doctor 
of  Divinity,  presented  by  Mr.  Philemon  H.  Tuck  ; 
Edgar  Hilliary  Clans,  Doctor  of  Laws,  presented 
by  Judge  Henry  D.  Harlan,  and  Robert  Dorsey 
Coale,  Doctor  of  Medicine,  presented  by  Dr.  Ran- 
dolph Winslow.  Professor  Winslow,  in  recom- 
mending Dr.  Coale  for  the  degree,  made  the  fol- 
lowing remarks : 

"Mr.  Provost — I  have  the  honor  to  present  for 
the  degree  of  Doctor  of  Medicine,  honoris  causa, 
one  whom  the  Regents  have  adjudged  worthy  of 
this  distinction  and  whose  name  is  mentioned  in 
their  mandate.    Robert  Dorsey  Coale,  for  28  years 
professor  of  chemistry  and  toxicology  in  the  Uni- 
versity of  Maryland,  and  for  the  past   12  years 
dean  of  the  Medical  Faculty  of  the  same  institu- 
tion.    Born  and   raised   in   Baltimore,   Professor 
Coale  received  his  early  education  in  the  private 
schools  of  this  city,  but  having  a  predilection  for 
military  life,  he  entered  the  Pennsylvania  Military 
Academy  at  Chester,  Pa.,  from  which  he  gradu- 
ated in    1875.     Upon  the  opening  of  the  Johns 
Hopkins  University  in  1876  he  became  a  student 
in  the  department  of  chemistry,  and  he  has  the 
distinction  of  having  been  the  first  matriculate  of 
this  famous  institution,   from  which  he  received 
the  degree  of  Doctor  of  Philosophy  in  1881.     In 
1883  he  was  made  lecturer,  and  in  1884  professor 
(jf  chemistry  and  toxicology  in  the  University  of 
Maryland,  of  which  chair  he  is  still  the  incum- 
bent.    In  addition  to  his  activities  as  teacher  and 
chemist,  he  has  been  especially  identified  with  the 
Maryland  National  Guard,  and  upon  the  outbreak 
of  the  Spanish-American  War  was  commissioned 
Colonel  of  the  Fifth  Maryland  Regiment,  U.  S. 
V.,  Infantry,  and  served  in  the  field  with  this  regi- 
ment during  the  hostilities.     In  consideration  of 
his  scientific  attainments  and  the  valuable  services 
rendered  the  ?\ledical  School  during  many  years, 
I   request  that  be  lie  admitted  to  the  degree  of 
Doctor  of  Medicine  in  this  University,  honoris 
causa. 


The  financial  report  for  The  Alumni  Athletic 
Association  of  the  University  of  Maryland,  Inc., 
for  the  past  year  is  as  follows : 

Receipts. 

Membership  dues $314  50 

Sale  of  theater  tickets 267  00 

Donation  from  Law  School 50  00 

Donation  from  Dental  Department 44  00 

From  raffle  of  instruments 89  80 

Guarantees,  etc.,  received  from  track  team 14  00 

Guarantees,  etc.,  received  from  lacrosse  team. .  .  16  60 

Guarantees,  etc.,  received  from  baseball  team.  .  .  133  00 

Guarantees,  etc.,  received  from  basket-ball  team  326  27 

Total  receipts $1255  17 

Disbursements. 
Theater  Benefit — 

Paid  Academy  of  Music $158  75 

Printing,  etc 12  65 

Postage  on  tickets IS  26 

Refund  over-payment 2  00 

$188  66 

Track  Team — 

Suits,  pole  and  shot $43  65 

Printing 5  00 

Expenses  to  meet 74  52 

Medals  for  meet 41  00 

164  17 

Basket-ball  Team — 

Equipment $101  00 

Printing,  postage,  etc 9  00 

Expenses  to  games 308  81 

418  81 

Lacrosse  Team — 

Stationery $3  00 

Postage 1  00 

Expenses  to  Annapolis IS  00 

Equipment 28  80 

47  80 

Baseball  Team — 

Expenses  to  games $255  00 

Equipment — part  payment 25  00 

280  00 

Association  Expenses — 

Stationery  and  supplies $40  20 

Postage   (stamped  envelopes) 20  80 

Clerical  work 2  00 

Gists  incorporation 8  00 

Membership  A.  A.  U 7  50 

78  50 

Miscellaneous — 

Two  footballs $10  00 

Use  M.  A.  C.  grounds 5  00 

Walbrook  Athletic  Club 25  00 

Instruments  for  raffle 28  00 

68  00 

$1245  94 
Balance  May  30,  1912 $0  23 


THE   HOSPITAL    BULLETIN 


79 


ENGAGEMENTS 

The  engagement  is  announced  of  Dr.  Howard 
J.  Maldeis,  class  of  1903,  of  437  East  25th  street, 
Baltimore,  to  Miss  Louise  Cecil  Watkins, 
daughter  of  Mr.  and  Mrs.  W.  M.  Watkins  of 
Kate  avenue,  Arlington,  Md.  The  wedding  will 
take  place  in  the  early  fall.  Miss  Watkins  was  a 
member  of  the  class  of  1913,  University  Hos- 
pital Training  School  for  Nurses. 


MARRIAGES 

Dr.  William  Shepherd  Hall,  class  of  1899,  of 
S14  Park  avenue,  Baltimore,  was  married  to 
.Mrs.  Katherine  Turner  Kurtz  of  Roland  Park, 
in  Philadelphia,  June  1,  1912.  The  wedding  was 
witnessed  by  the  young  son  of  the  bride,  her 
cousin  and  brother-in-law. 


BIRTHS 

In  March,  1912,  to  Dr.  Granville  Hampton 
Richards,  class  of  1908,  and  Mrs.  Richards,  of 
Port  Deposit,  Md.,  a  daughter.  Mrs.  Richards 
was  Miss  Mary  Emma  Wright,  class  of  1908, 
University  Hospital  Training  School  for  Nurses. 


February  3.  1912,  to  Dr.  Jacob  Wheeler  Bird, 
class  of  1907,  and  Mrs.  Bird,  a  daughter,  Helen 
Brayshaw  Bird.  Mrs.  Bird  was  Miss  Mary 
Mclntire  Wilson,  of  Centerville,  and  former  as- 
sistant superintendent  of  nurses  in  the  University 
I  Tospital. 


DEATHS 

Dr.  Josiah  R.  Bromwell,  class  of  187 1,  of 
Washington,  D.  C,  died  at  his  home,  1147  Con- 
necticut avenue.  May  25,  19x2,  after  a  lingering 
illness.  He  was  a  native  of  Frederick  County, 
and  after  graduation  located  in  Loudoun  County, 
Va.,  where  he  remained  for  ten  years,  spending 
the  past  thirty  in  Washington.  He  is  survived 
by  his  brother,  Dr.  John  Bromwell,  class  of  1807, 
of  Mount  Airy,  Md.  Dr.  Bromwell  was  buried 
in   London  Park  Cemetery,  Baltimore. 


Dr.  Ephriam  Hopkins,  class  of  1859,  died  at 
his  home  in  Darling-ton,  Harford  County,  Md., 
Saturday,  May  11,  191 2.  aged  75  years.  Dr.  Hop- 
kins was  the  son  of  the  late  Dr.  Wakeman  B. 
Hopkins,  class  of  1828,  and  Mrs.  Hannah  R. 
I  [opkins,  and  cousin  of  the  late  Dr.  William 
W'orthington  Hopkins,  class  of  1858,  who  died 
August  4,  191 1.     Dr.  Ephriam  Hopkins  was  born 


in  1837  near  Darlington,  Md.,  and  received  his 
earlier  education  in  the  schools  of  that  vicinity, 
later  matriculating  at  the  University,  from  which 
he  was  graduated  with  honors  in  1858.  For  a 
time  he  practiced  in  Darlington,  then  located 
about  four  miles  from  West  Chester,  Pa.,  where 
he  had  entire  medical  charge  of  the  large  Chester 
County  Almshouse,  with  a  department  for  the 
insane,  and  here  did  the  work  of  two  physicians, 
as  this  almshouse  was  at  that  time  also  the  hos- 
pital of  the  county.  About  1895  Dr.  Hopkins  re- 
turned to  Darlington  and  purchased  the  beautiful 
Joseph  Jewett  residence,  where  he  resided  until 
his  death.  He  married  Miss  Rachael  M.  Johnson, 
a  lady  of  rare  talents,  who  survives  him.  Two 
sisters  and  a  brother  are  still  living.  Dr.  Hopkins' 
two  sons  died  some  years  ago,  just  as  they  were 
about  grown.  He  was  a  loyal  member  of  the 
Society  of  Friends,  and  counted  his  warmest 
friends  among  its  members. 

Dr.  Hopkins  was  an  alumnus  of  whom  the 
University  may  always  he  proud.  Never  robust, 
yet  possessed  of  indomitable  energy,  he  success- 
fully conducted  a  practice  that  many  men  half 
his  years  could  not  have  attempted.  His  practice 
was  widespread  and  his  neighborly  spirit  kindly 
enough  to  make  no  distance  too  great  if  he  could 
alleviate  suffering  by  his  presence.  He  was  a 
keen  diagnostician,  a  tactful  physician,  a  splendid 
and  kindly  nurse,  and  a  friend  to  all  of  his  patients 
and  neighbors.  He  was  one  of  the  few  physicians 
who  possessed  business  ability  in  combination 
with  professional  skill. 

His  death  was  undoubtedly  due  to  his  devo- 
tion to  his  duty,  as  his  last  illness  was  contracted 
through  taking  a  patient  to  a  hospital.  His  physi- 
cians agreed  that  he  literally  laid  down  his  life  for 
another,  following  the  call  of  duty  as  he  saw  it. 
His  life  was  markedly  free  of  excess  of  any  kind, 
and  he  was  always  so  active  he  seemed  a  very 
part  of  the  community  in  which  he  lived. 

Dr.  Nathan  R.  Smith,  late  professor  of  surgery 
in  the  University,  wrote  of  Dr.  Hopkins  to  a 
colleague  as  follows : 

"It  gives  me  great  pleasure  to  bear  testimony 
to  the  superior  intelligence  and  industry  with 
which  he  has  distinguished  himself  in  the  pursuit 
of  his  studies,  taking  the  very  front  rank  of  his 
class.  He  has  witnessed  much  of  my  private 
practice,  aided  me  in  many  operations,  and  him- 
self operated  skillfully  under  my  observation,  and 
I,    without    reserve,   commend    him    to    all    with 


8o 


THE    HOSPITAL   BULLETIN 


whom  my  name  has   influence  as  one  in  every 
respect  worthy  of  entire  confidence." 

Dr.  Hopkins  was  buried  in  Darlington  Ceme- 
tery. Messrs.  Charles  Y.  Thomas  and  Thomas 
Wheeler  of  the  Society  of  Friends  officiated.  The 
pallbearers  were  Messrs.  Johns  Hopkins,  Thomas 
C.  Hopkins,  James  Massey,  William  Dick,  Wil- 
liam Scott  and  Norman  Smith. 


OLDEST    ALUMNUS    DIES. 

We  have  just  learned  of  the  death  of  Dr. 
Humphrey  E.  Bowman,  class  of  1839,  on  April 
29,  191 2,  at  the  home  of  his  daughter  in  Farming- 
ton,  Iowa.  Dr.  Bowman  was  the  oldest  living 
alumnus  of  the  University  for  several  years  pre- 
ceding his  death,  and  we  regret  that  we  did  not 
know  this  and  accord  him  earlier  the  recognition 
this  fact  merited.  We  believe  the  honor  now 
goes  to  Dr.  John  VV.  C.  O'Neill,  class  of  1844, 
of  Gettysburg,  who  was  born  in  1821,  with  a 
close  second  in  Dr.  John  J.  R.  Krozer,  class  of 
1848,  of  Baltimore,  who  was  born  in   1827. 

Dr.  Bowman  was  born  in  Loudoun  County, 
Ya.,  August  17,  1818,  and  grew  to  young  man- 
hood there.  He  received  his  higher  education  at  the 
College  at  Marietta,  Ohio,  later  matriculating  at 
the  University  and  graduating  in  1839.  He 
located  at  Shelbyville,  Mo.,  and  practiced  there 
and  in  Newark,  Mo.,  for  over  thirteen  years. 
Fie  returned  to  Baltimore  two  years  after  his 
graduation  to  marry  Miss  Ann  M.  Ellery.  After 
leaving  Newark  he  engaged  in  mercantile  pur- 
suits at  various  places,  relinquishing  medicine 
because  of  failing  health.  In  1861  he  went  to 
Iowa,  locating  at  Farmington,  where  he  has  since 
made  his  home,  with  the  exception  of  a  short 
time  spent  in  Missouri  immediately  following  the 
Civil  War  and  a  brief  period  spent  later  in  Chi- 
cago. He  lived  for  many  years  with  the  daughter 
at  whose  home  he  died — Mrs.  James  W.  Lapsley. 
He  is  survived  by  five  children,  W.  H.  Bowman 
of  Keokuk,  Iowa;  C.  A.  and  C.  H.  Bowman  of 
Mt.  Sterling;  Mrs.  James  Lapsley  of  Farmington, 
and  Airs.  E.  E.  French  of  Chicago,  111.;  and 
seven  grandchildren  and  two  great  grandchildren. 
At  the  time  of  his  death  he  was  almost  ninety- 
four  years  of  age,  and  one  of  the  oldest  citizens 
of  Van  Buren  County,  and  probably  one  of  the 
oldest  graduate  physicians  of  Iowa. 

Added  to  his  keen  intelligence  he  possessed  a 
fund  of  wit  and  humor  that  delighted  those  for- 
tunate enough  to  know  him.     For  years  it  has 


been  his  fancy  upon  each  recurring  birthday  to 
write  a  verse  or  verses  appropriate  to  the  oc- 
casion. Perhaps  it  would  be  a  letter  of  thanks 
for  some  little  token  of  remembrance,  or  perhaps 
an  expression  of  his  own  feelings. 

The  Daily  Gate  City  of  Keokuk  writes  of  him : 
"Dr.  Bowman  always  retained  the  tine  bearing 
of  a  typical  Southern  gentleman.  Tall  and  straight 
as  an  arrow  always,  despite  the  weight  of  many 
years.  His  intellectual  faculties  were  unimpaired 
through  all  his  long  life.  He  had  lived  in  Iowa 
for  many  years  and  his  individualitv  was  so 
marked,  and  his  goodheartedness  and  cheer  ex- 
tended to  all  with  whom  he  was  associated,  that 
his  acquaintance  was  far  extended.  He  was 
always  proud  of  the  State  of  his  nativity  and  of 
his  lineage.  His  career  in  life  was  straight  and 
true,  and  his  ideals  high.  Thus  he  lived  and 
bore  with  him  the  good  will  of  his  neighbors. 
and  dying  he  is  mourned  with  a  deep  sorrow." 

Dr.  Joseph  C.  Benzinger,  class  of  1863,  died 
at  his  home,  1906  E.  Baltimore  street.  Baltimore, 
May  4,  1912,  of  heart  disease,  aged  68  years. 
Dr.  Benzinger  was  a  surgeon  of  Volunteers  dur- 
ing the  Civil  War. 


DISPENSARY    CASES. 
April  i,  191 1,  to  April  i.   1912. 

Clinics.                    New.  Old.  Total. 

1— Surgical 1754  5392  7*4$ 

2 — Genito    Urinary.  .      721  3033  3754 

3 — Medical 120S  2300  3517 

4 — Eye  and  Ear 740  1200  1940 

5 — Women 604  1087  1691 

6 — Nervous 286  1 383  [669 

7 — Children 605  843  [448 

8— Stomach 424  889  1313 

9 — Throat 562  688  1250 

10— Lung 492  (\V'  1 128 

1 1 — Skin 297  479  776 

12 — Orthopedic 40  40  80 

13— Rectal 41  38  79 

Total 7774        18,017        25,791 

Total    new   cases 7-774 

Total  old  cases 18,017 

Grand  total 25,791 

John  Houff,  M.D.. 
Dispensary  Physician. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 
PRICE    $1.00    PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  608  Professional  Building,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.    VIII 


BALTIMORE,  MD.,  JULY  IS,   1912. 


No.  5 


A    STUDY   OF   THE   SYNCHRONOUS 
HEART   BEAT  AND  RESPIRA- 
TION' IN  THE  MUSTELUS 
CANIS. 


From   the    U.   S.    Bureau  of   Fisheries  Labora- 
tories, Woods  Hole,  Mass.) 


By  Albert  Hynson  Carroll.  M.D. 


The  following  experiments,  which  I  had  not 
heretofore  considered  of  marked  physiological 
interest,  appear  in  a  new  light  since  the  publica- 
tion of  Hemmeter's  important  contribution  to  the 
comparative  physiology  of  the  circulation  in  the 
"dogfish."  Xo.  1  (Zeitschrift  fur  Biologische 
Technik  mid  Methodik,  Bd.  2.  p.  236,  Nov.,  191 1  ). 

The  friendly  controversy  between  this  author 
and  Prof.  Leon  Fredericq  which  followed,  Xo.  2 
(Tin-:  Hospital  Bulletin,  May  15,  1912,  page 
No.  1.  Vol.  8).  evidenced  the  lively  interest  mani- 
fested in  the  scientific  world  concerning  any  new 
contribution,  and  induces  me  to  publish  the  ex- 
periments which  led  me  to  the  discovery  that  the 
heart  beat  and  respiration  in  the  resting  dogfish 
are  concurrent,  i.  e.,  have  a  ratio  of  "1  to  I." 

Such  a  ratio  has  been  reported  in  man  in  one 
case  by  S.  \Y.  Morris.  No.  3  (Archives  of  Inter- 
nal Medicine,  iyii.  p.  691.  Synchronous  Cardiac 
and  Respiratory  Rate). 

The  pathological  picture  was  a  complicated  one. 
II ere  there  existed  an  aortic  mitral  and  tricuspid 
insufficiency,  with  hypertrophy  and  dilation  ac- 
companying  passive  congestion  of  the  lungs. 

The  tracings  from  the  jugular  pulse  and  apex 
beat  definitely  eliminated  the  possibility  of  either 
heart  block  or  a  pseudo-bradycardia  resulting 
from  extra  systoles.  In  this  pathological  state 
the  intra-thoracic  pressure  determined  to  a  great 
extent  the  heart  rate. 

This  extreme  ease  points  to  the  urgent  neces- 
sity for  a  thorough  physiological  training  of  the 
members  of  the  medical  profession. 


Such  training  is  necessarily  based  on  knowl- 
edge gained  through  constant  searching  for  new 
truths.  A  physiological  phenomenon  may  lie 
marked  or  obscure  in  a  lower  form.  A  compara- 
tive study  broadens  and  strengthens  our  concept 
of  these  vital  principles. 

That  the  heart  beat  and  respiration  in  animals 
bear  a  certain  definite  ratio  to  each  other  is 
familiar  to  all.  I  nder  normal  conditions  it  is 
quite  constant.  It  is  about  "4  to  1"  in  man.  In 
the  mustelus  canis  I  have  found  it  to  lie  "1  to  1" 
under  normal  conditions.  This  unusual  ratio  is 
exhibited  with  great  constancy. 

The  dogfish  can  be  secured  in  unlimited  quan- 
tities. It  is  admirably  adapted  for  physiological 
experimentation.  The  blood  stream  can  be  either 
inhibited  or  lessened  at  will  by  vagus  stimulation, 
or  accelerated  by  stimulating  certain  areas  which 
appear  to  be  analogous  to  the  sinus  node  of  Keith 
and  Flack.  Xo.  4  (Altered  Respiration  and  Its 
Effect  on  the  Heart  Beat)  has  been  studied  and 
the  effects  of  various  chemicals  have  been  investi- 
gated, and  will  appear  in  a  later  paper. 

In  earlier  experiments  on  the  heart  beat  and 
respiration  of  the  dogfish,  working  with  Dr.  J.  C. 
llemmeter,  we  attempted  to  demonstrate  a  syn- 
chronous heart  beat  and  respiration  by  placing  a 
soft  rubber  ball  connected  with  a  tambour  in 
the  pharynx  of  the  fish,  by  inserting  a  cannula 
connected  with  a  recording  mercury  manometer 
into  the  pericardial  cavity  and  recording  the  two 
tracings  simultaneously. 

Although  records  from  each  were  obtained. 
nothing  definite  was  demonstrated.  The  negative 
results  were  probably  due  to  the  physiological 
and  mechanical  disturbances  caused  by  the  bulky 
mass  in  the  pharynx,  and  because  the  condition 
nf  sub-atmospheric  pressure  normally  present  111 
the  pericardial  cavity  was  undoubtedly  destroyed. 
And  perhaps  partly  because  of  the  mechanical 
irritation  to  the  heart  as  it  beat  against  the  can- 
nula. 


THE    HOSPITAL    BULLETIN 


Later,  however,  I  was  able  to  demonstrate  that 
this  supposition  was  a  correct  one. 


1— ANTERIOR. 


processes  which  bring  about  and  maintain  heart 
rhythm.  Whatever  the  governing  factors  may  be, 
the  activity  of  these  centers  depends  upon  a  "nor- 
mal supply  of  balanced  blood,"  as  emphasized 
by  I.oeb  and  so  clearly  demonstrated  by  Linhard 
and  others.  No.  5  (J.  Linhard,  The  American 
Journal  of  Physiology,  May,  191 1). 

It  appears  that  the  balance  is  determined  largely 
by  the  CO,  content,  and  that  the  excitabilitv  of 
the  respiratory  center  toward  the  adequate  stimu- 
lus to  activity  is  governed  by  the  O  tension 
present. 

The  heart  is  the  mechanical  means  or  pump, 
the  proper  functioning  of  which  determines  the 
blood  flow  to  the  respiratorv  centers.     Hence,  if 


•OSTKRJOR. 


we  alter  the  rate  or  force  of  the  heart,  we  alter 
the  quantity  of  blood  pumped,  and  we  expect  to 
observe  corresponding  changes  in  the  mechanical 
response  of  the  respiratory  muscles. 

Similarly,  if  we  experimentally  alter  the  re- 
spiratorv movements,  we  will  alter  the  nature  of 
the  blood,  and  particularly  will  we  alter  the  flow 
of  the  blood  in  the  mustelus  canis. 

In  a  dogfish  the  pericardial  cavity  is  analogous 
to  the  thoracic  cavity  in  mammals.    A  portion  of 
2— LATERAL.  its  walls  are  elastic.     To  the  fixed  and  elastic  por- 

tions   are    attached    a    series    of    muscles    which 
It  is  not  my  object  in  this  paper  to  investigate      shorten  at  each  respiration.     Each  respiration  is 
the  physiologj   of  the  respiratory  center  or  those      accompanied  by  a  swallowing  movement,  which 


THE    HOSPITAL    BULLETIN 


83 


alters  the  pull  of  these  muscles  at  their  attach- 
ments and  markedly  alters  the  negative  intra- 
pericardial  pressure.  Each  inspiration  favors 
diastolic  tilling  and  expiration  assists  systolic 
empt)  ing  <  if  the  heart. 

DESCRIPTION   OF    PERICARDIAL   SAC. 

Space  prevents  giving  but  a  brief  description 
of  the  tissues  which  act  mechanically  during  res- 
piration in  bringing  about  a  rhythmical  altera- 
tion in  the  negative  intra-pericardial  pressure. 

The  drawings  No.  1,  Xo.  2  and  Xo.  3,  from  .1 
wax  cast  of  the  pericardial  sac.  show  the  anterior, 
lateral  and  posterior  views  of  the  dilated  peri- 
cardium. 

The  heart-shaped  portion  of  Xo.  1  is  occupied 
by  the  ventricle  V,  and  is  firmly  attached  to  and 
underlies  the  caricoid  cartilage.  The  portions  of 
Xo.  2  marked  M  and  (a-b)  ( c-d )  represent  the 
attachment  of  the  upper  three  of  the  five  pairs 
of  respiratory  muscles,  which  are  attached  to  the 
most  movable  portions  of  the  pericardium.  S.  S. 
are  lateral  margins  of  the  venous  sinus  where 
the  blood  from  the  lateral  sinuses  and  the  vagus 
fibres  enter. 

Fig.  2,  "K"  is  the  mesial  line  where  the  anterior 
margins  of  the  auricle  approach  each  other.  It 
will  be  noted  that  the  portion  of  the  heart  sac 
containing  the  auricle  is  much  larger  than  the 
portion  containing  the  ventricle  V  (about  3  to  1  ). 

Fig.  3.  H.  S.  are  the  points  of  entrance  of  the 
vessels  from  the  abdomen.  V  ventricle.  A  au- 
ricular portion. 

The  pericardium  lies  between  the  clavicles  and 
ventral  to  the  esophagus.  It  contains  the  sinus 
venoses,  (  S.  V. ) ,  Xo.  2  the  auricle  (  A  )  and  the 
ventrical  (V).  The  caudal  portion,  or  base  (  W  ). 
is  occupied  by  the  thin-walled  but  rather  inelastic 
venous  sinus  and  the  auricle.  The  sinus  is  trans- 
versely placed,  and  is  somewhat  diamond-shaped. 
The  cuvierean  ducts  empty  into  it  laterallv  (  S.S. ). 

Cranial  to  the  sinus  the  sac  is  enlarged  and 
rounded  for  the  very  thin  and  elastic  walled 
auricle.  Ventral  to  the  latter  portion  is  the  some- 
what rounded  pyramidal  portion,  with  its  apex- 
directed  caudad,  in  which  lies  the  ventricle.  The 
aorta  D  occupies  the  apical  portion. 

Leading  from  the  pericardium  is  a  large  open- 
ing into  the  abdominal  cavity,  the  pleuro-perito- 
neal  canal.  Two  hepatic  sinuses,  placed  close 
together  mesially,  enter  the  venous  sinus  from  the 
abdomen  and  carrv  visceral  blood  to  the  sinus. 


The  base  is  somewhat  concave,  broader  vcntrally 
than  posteriorly.  The  dorsal  half  is  quite  flexible, 
and  is  occupied  by  part  of  the  auricle.  The  an- 
terior walls  near  the  base  are  rigidly  fixed  to  the 
overlying  cartilaginous  pectoral  arch.  The  lateral 
walls  are  also  rigidly  attached  near  the  ba>c. 

There  are  several  ways  in  which  the  pressure 
within  the  cavity  can  be  altered.  The  lateral 
sides  are  rounded  and  approach  others  in  the 
ventral  mesial  line.  ( K )  Xo.  2.  These  walls 
also  are  flexible  (a-b;  c-d),  and  are  capable  of 
being  moved  inward  and  outward  by  the  action 
of  the  muscles  attached  to  them.  Five  peniform 
bilateral  sets  of  muscles  are  attached  to  the  sides 
of  the  sac  (M),  and  extend  to  the  gill  arches. 
These  are  the  principal  inspiratorv  muscles.  Each 
inspiration  shortens  these  muscles,  three  pairs  of 
which  are  connected  with  the  movable  portions 
of  the  pericardium,  thus  increasing  its  capacity. 

This  pressure  is  also  altered  by  each  dilation 
and  contraction  of  the  heart  chambers.  A  ma- 
nometer connected  with  a  cannula,  carefully  in- 
serted into  the  sac  through  the  pectoral  arch, 
shows  this  to  be  a  fact  when  the  respiration  is 
artificially  stopped. 

Again,  the  apex  of  the  pericardium  is  drawn 
downward  at  each  inspiration.  This  was  shown 
by  watching  the  movements  of  one  end  of  a 
curved  wire  which  had  been  inserted  through  a 
small  opening  in  the  pectoral  girdle,  the  other  end 
of  which  rested  in  the  apex.  When  the  respira- 
tory group  of  muscles  pull  upward  and  outward 
on  the  sides  of  the  sac,  the  acute  apical  angle  is 
widened  as  the  apex  approaches  the  base,  and  the 
capacity  of  the  cavity  is  increased. 

The  result  of  this  rhythmical  alteration  at  each 
respiration  and  heart  beat  is  the  drawing  into 
the  sinus  and  auricle  of  the  venous  blood.  A 
true  estimation  of  the  importance  of  this  me- 
chanical effect  on  the  heart  beat  is  only  had  when 
the  extremely  low  blood  pressure  in  the  veiv  >us 
system  in  the  dogfish  is  appreciated. 

METHODS. 

A  medium-sized  dogfish  (80  cm.  in  length  )  was 
selected  and  placed  in  a  tank  of  fresh  sea  water 
and  allowed  to  become  accustomed  to  its  new 
surroundings.  At  the  end  of  a  half  hour  its 
respiration  was  counted.  It  was  then  placed  in 
a  box-like  operating  holder,  ventral  surface 
uppermost,  and  securely  fastened  with  bands 
around  the  nose,  just  dorsad  to  the  pectoral  fins 


84 


THE    HOSPITAL    BULLETIN 


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NO.    1— TAIL    ELEVATED. 


NO.  3— TAIL  AGAIN  ELEVATED  AND  1  TO  1  RATIO  RE- 
ESTABLISHED.  (THE  DRUM  HAD  TO  BE  MOVED 
EACH  TIME  THE  FISH  WAS  CHANCED  IN  POSITION 
IN    ORDER    TO    READJUST   THE    WRITING    LEVERS. 


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SHOWING 


Nil.  2— TAIL  AND  HEAII  AT  THE  SAME  LEVEL.  IiLllllJi 
NUT  ENTERING  VENUES  SINES  IN  SUFFICIENT 
QUANTITY  Til  FILL  THE  VENOUS  SINES  AND  I'D 
STIMULATE  IT  TO  "SET  THE  PACE."  HEART  28, 
UESP.  56. 

4,    5,    6— TRACING    Nos.    1.    2    AND   3. 
THE    CONCURRENT    HEART    HEAT    AND    RESPIRATORY    EFFORT— RATIO    OF    1    TO    1. 


THE   HOSPITAL    BULLETIN  85 

and  around  the-  tail,  replaced  in  the  tank  of  water  angular  opening  centrally   through   the  caracoid 

and  another  respiratory  count  made  and  recorded,  cartilage.     Great  care  is  used  to  avoid  trauma  to 

first,  with  the  dorsal  surface  uppermost;  second,  the  heart,  which  almost  completely  tills  the  peri- 

with  the  ventral  surface  uppermost:  third,  with  cardium.     The  opening  is  then  extended  forward 

the  head  elevated,  and  fourth,  with  it  depressed,  about  1  cm.,  sufficiently  to  expose  the  heart.    The 

In  view  of  the   later  observations,  it  is  inter-  box  is  again  placed  in  the  sea  water  tank  with  the 

esting  to  note  that  there  was  practically  no  re-  mouth   and   gills   submerged.      If  heart  tracings 

spiratory  alteration  following  these  alterations  in  are    desired,    the    apex    of    the   ventricle   can    be 

position.     (See  table  No.  1,  Exp.  1.)  picked  up  with  small  blunt  forceps  and  a  thread 

When  it  is  nece.sarv  to  operate,  a  light  anes-  tied    around    tlle   dP    of    il-      Another   thread    is 

thesia.  one  just  sufficient  to  last  until  the  heart  attached  to  the  skin  by  a  sharp  hook  above  the 

was  exposed,  was   found  to  be  better  than  deep  th,rd  P11  arch  aml  somewhat  laterally  to  record 

anesthesia.     Ten  c.c.  of  a   10  per  cent,  alcoholic  an-v    respiratory    movement.     These   threads   are 

solution  of  chloratone  in  1000  parts  of  sea  water  connected  to  the   recording  levers  of  a  kymog- 

proved   to   be   an   excellent  anesthetic,   and   was  raP  110n' 
almost  universally  used.  August  28.  191 1.     Experiment  No.  1.    Effect 

When  from  shock  or  from  some  other  unex-  °"  Respiration  by  Changing  the  Position  o\  the 
plained    cause   the    heart   of   a   dogfish   or   sand 

shark  was  found  to  exhibit  fibrillary  contractions.  A  sma11  fish  was  secured  in  the  holder  and  the 

a  mild  stimulation  of  the  vagus  for  a  few  seconds  holder  versed   vertically  with   the  fish's  head 

would   usually  restore   it   to   its   normal    rhythm.  "Ppermost  and   just  beneath  the  surface  of   the 

This  was  interesting,  since  it  recalled  that  Garrev,  water-     ResPlratoI7   rate  varied   from  45   to  47 

No.  6  (Walter  E.  Garrey,  American  Journal  of  durmS  the  following  »our ;  10  A.  M,  respiration 

Physiology,     1892.    Some    Effects    of    Cardiac  46;  10.30  A.  M.,  respiration  45;  12  M.,  respira- 

Nerves  Upon  Vent.  Cont).  experimenting  with  tlon  445  5  P-   M-  respiration  46;  July  27.  9.30 

dogs"  hearts,  found  that  vagus  stimulation  only  A'  M-  respiration  46. 

met  with  a  small  percentage  of  success,  and  then  The  fish  vvas  now  allowed  to  swlm  freely  in  the 

when  the  dogs  were  in  a  very  poor  condition.  tank'    an<1    aPPeared    perfectly    normal.      It    was 

again   secured  and  placed   in   the   holder   in   the 

to  expose  the  heart  and  the  vagus   nerves.  Nvater  tank,  head  downward,  overnight:  9.40  A. 

No.  7.     For  a  detailed  description  of  the  tech-  M.,  respiration  48;  10.30  A.  M.,  respiration  48; 

nique  of  exposing  the  heart  and  vagus  nerves  as  T-2  M.,  respiration  46 ;  6  P.  M.,  respiration  47. 
developed    by    Hemmeter    and    the    author,    see  The  fish  was  then  placed  laterally  in  the  water. 

Zur   Technik  von    Vagusexperimenten   am  Scyl-  ventral  surface  downward.     Respiration  was  47, 

Hum.     Zeitschrift  fur  Biohgische   Technik   and  and  remained  constant  for  an  hour.     It  was  next 

Methodik,  Nov.,  191 1,  I.  C.  Hemmeter.  turned  over  with  the  dorsal  surface  downward. 

A  curved  incision,  reaching  from  one-fifth  gill  The    respiration    remained   at  47.      Position   evi- 

slit  to  the  other,  is  made  through  the  skin,  across  dently  affects  the  rate  of  respiration  but  little. 
and  above  the  pectoral  arch.     From  its  center  a  pjs)l     pj^      pjsh     pj  ^ 

forward  incision  is  made,  extending  well  up  to-         Exp.  No.  1.    Table  1.  No.  1.   No.  2.    No.  3.  No.  4. 

ward  the  mouth.     Starting  at  each  dorsal  crevice  Dorsal  surface  up Resp.    45         40         32         29 

of  the  fifth  gill  slit  an  incision  is  made  posteriorly  Ventral  surface  up Resp.    47         40         31         30 

to  the  laterallines,  and  then  carried  forward  along  Head  "p ResP-    -*6         4*         32         33 

,,       ..  nM_      1   ■.        1     1  -      a  Tail   up Resp.     48  40  \\  vt 

tlie  lines  3  to  5  cm.     The  lateral  skin  flaps  are  OJ         "" 

reflected.     Blunt   dissection   is  employed  if  it  is  August  31,  191 1.    Experiment  No.  2.     To  Dis- 

wished  to  expose  the  underlying  vagus  nerves.  cover  the  Ratio  of  Respiration  to  Heart  Beat  in 

The  "ramus  cardiacus"  is  found  on  each  side  the  Mustelus  Canis: 
entering  the  cuvierian  duct  or  sinus,  which  opens  A  fish  was  lightly  anesthetized  and  secured  in 

into  the  pericardial  sac.     The  ventral  skin  flaps  the  box-like  holder.     A  very  small  opening  was 

are  dissected  back  and  the  cartilagenous  pectoral  made  through  the  pectoral  arch,  just  sufficiently 

arch   laid  bare.     The   dissection   is   then  carried  large  to  observe  and  count  the  heart  beats.     The 

anteriorly  until  the  pericardium  is  reached.  holder  was  now  submerged  in  the  sea  water  tank 

The  heart  is  exposed  by  making  a  small   tri-  and    respiration    and    heart    rate    counted.      The 


86 


THE    HOSPITAL    BULLETIN 


heart  beat  only  once  in  every  two  respirations: 

Respiration  Q  A.  M.,  40;  9.15  A.  M.,  48;  10.30 
A.  M.,  52. 

Heart  9  A.  M.,  25;  9.15  A.  M.,  24:  10.30  A. 
M.,  26. 

Any  violent  effort  to  escape  would  be  followed 
by  an  irregularity  of  both  breathing  and  heart 
beat.  It  was  observed  that  at  times  a  firm  pres- 
sure when  holding  the  fish  quiet  on  the  abdomen 
■would  cause  a  short  period  of  synchronous  breath- 
ing and  heart  beating,  due  to  an  increased  flow 
of  venous  blood  into  the  heart  from  the  large 
abdominal  veins. 

It  now  occurred  to  me  that  since  the  opening 
of  the  pericardial  sac  had  negated  the  normal  sub- 
atmospheric  intra-pericardial  pressure,  that  the 
blood  was  not  returning  in  sufficient  quantity  to 
the  venous  sinus,  and  that  the  local  mechanical 
stimulating  effect  normally  due  to  its  pressure  was 
altered  or  lacking. 

I  elevated  the  tail  of  the  fish,  and  in  this  way 
"allowed  gravity  to  play  the  role  normally  enacted 
by  the  sub-atmospheric  intra-pericardial  pressure 
iu  filling  the  venous  sinus,"  making  an  angle  of 
about  20  degrees  with  the  surface  of  the  water. 

Almost  at  once  the  heart  rate  was  increased, 
equaling  the  number  of  respirations  per  minute, 
each  auricular  diastole  immediately  occurring 
after  the  closure  of  the  gill  clefts. 

The  opening  in  the  pericardium  was  enlarged. 
The  apex  of  the  ventricle  was  picked  up  by  small 
blunt  forceps  and  a  thread  tied  around  the  tip  of 
it.  Another  thread  was  attached  to  the  skin  by 
a  sharp  hook  above  the  third  gill  arch.  The 
threads  were  connected  to  the  recording  levers  of 
a  kvmographion.  In  a  few  moments  the  heart 
beat  and  respiration  ratio  became  *'i  to  I."  (See 
tracing  Nos.  1,  2,  3,  Exp.  2.) 

July  25,  191 1.  Experiment  Xo.  3.  Both  vagus 
nerves  exposed  and  pericardium  opened,  show- 
ing venous  sinus. 

"1"  shows  inhibitions  of  auricle  after  stimulat- 
ing right  vagus. 

"I1"  shows  inhibition  of  auricle  after  stimulat- 
ing left  vagus. 

A  and  A1=  auricle  accelerated  by  stimulating 
certain  as  yet  not  precisely  located  areas  in  the 
venous  sinus. 

Too  strong  a  current  causes  inhibition  due  to 
escaped  currents. 

July  26,  191 1.  Experiment  No.  /.  Right  and 
left  cardiac  branch  of  vagus  exposed  and  peri- 


cardium opened.  Auricle  and  ventricle  connected 
with  recording  levers.  Times  32  per  min.,  show- 
ing that  both  auricle  and  ventricle  can  be  accel- 
erated as  well  as  inhibited  bv  stimulating  the 
vagus  and  the  "accelerator  areas"  in  the  venous 
sinus. 

It  will  be  evident  from  a  study  of  the  tracings 
that  this  acceleration  of  the  auricle  and  ventricle 
is  a  true  acceleration,  and  not  a  fibrillation.  The 
Y.  S.,  which  apparently  contains  in  its  walls  cer- 
tain as  yet  illy-defined  accelerator  fibres,  is  the 
pacemaker  for  the  beat.  It  always  beats  first  in  a 
strong  heart,  i.  c.,  one  in  good  condition.  Again, 
I  have  cut  both  vagus  branches,  singly  and  simul- 
taneously, and  noted  that  there  was  no  alteration 
of  the  heart  beat  or  the  blood  pressure.  No  ac- 
celerator nerve  or  branch  of  the  sympathetic  ner- 
vous system  has  been  found  leading  into  the  heart 
tissue  by  various  earnest  biologists  and  campara- 
tive  anatomists.  It  appears  to  me  that  I  have 
demonstrated  that  the  heart  beat  originates  in  the 
V.  S.,  and  that  a  balanced  blood,  at  a  definite 
pressure  and  quantity,  determines  the  rate  of  the 
heart  beat  by  its  mechanical  as  well  as  perhaps  its 
local  chemical  action  on  these  pace-making  and 
accelerator  venous  sinus  areas. 

The  rigid  structure  of  the  cartilaginous  walls 
of  the  vessels  or  channels  leading  into  the  V.  S. 
laterally  precludes  the  possibility  of  the  beat  origi- 
nating in  them. 

CONCLUSIONS. 

First — The  negative  intra-pericardial  pressure 
is  altered  markedly  at  each  respiratory  effort  in 
the  mustelus  canis,  but  is  always  a  negative  pres- 
sure ;  otherwise,  the  low  blood  pressure  in  the 
venous  system  would  not  cause  the  blood  to  enter 
the  Y.  S. 

Second — Without  a  proper  amount  of  fluid, 
mechanical  as  well  as  a  possible  local  chemical 
stimulation  to  a  normal  beat  is  lacking. 

Third — Accelerator  fibres  do  not  appear  to 
exist  in  the  main  vagus  trunks,  and  none  have 
been  observed  macroscopically  to  enter  the  heart 
tissue  by  way  of  the  venous  channels,  but  there  are 
certain  areas  in  the  walls  of  the  Y.  S.  which  posi- 
tively respond  to  stimulation  with  a  weak  current. 

Note. — I  wish  to  thank  Dr.  Hemmeter  for  en- 
couragement which  led  to  the  observing  of  these 
phenomena,  and  the  University  of  Maryland 
Laboratories  for  the  use  of  apparatus,  and  Dr. 


THE   HOSPITAL    BULLETIN 


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THE    HOSPITAL    BULLETIN 


Francis  B.  Summer,  Director  of  the  U.  S.  Fish- 
eries Laboratories,  Woods  Hole,  for  an  abundance 
of  experimental  material. 

906  N.  Calvert  St.,  Baltimore. 


IMPROVED  TREATMENT  OF  TUBERCU- 
LAR BONE  ABSCESSES.* 


By  \V.  Saulsbury  Niblett,  M.D.,  1911. 


Since  the  recognition  of  tubercular  abscesses 
and  sinuses  the  evolution  of  the  treatment  has 
been  more  or  less  in  a  chaotic  state,  and  is  far  from 
satisfactory.  Many  methods  have  been  suggested 
and  tried,  but  the  attempt  to  go  into  this  subject 
very  deeply  is  confusing  and  almost  hopeless  as 
to  the  enumeration  of  the  various  methods  of 
treatment;  therefore,  the  object  of  this  paper  is  in 
the  nature  of  a  small  contribution  of  our  experi- 
ence at  the  Kernan  Hospital  and  the  Hospital  for 
Crippled  Children,  and  while  we  all  agree  that  the 
subject  is  as  yet  meager,  we  will  give  the  meth- 
ods of  treatment  that  have  come  under  our  own 
observation. 

It  might  be  well,  before  we  consider  the  treat- 
ment to  briefly  summarize  the  pathological 
changes  that  take  place  in  the  development  of 
tubercular  abscesses  and  subsequent  sinus  for- 
mation. 

The  cause  of  the  disease  has  been  known  since 
the  time  of  Koch,  but  the  exact  pathology  is  con- 
fusing, this  being  especially  so  in  joint  tubercu- 
losis. The  tubercle  bacillus  enters  the  spongy 
portion  of  the  body  of  the  vertebra  and  in  the 
marrow  of  the  spongy  portion  of  the  ends  of  long 
bones,  and  not  the  shaft.  As  you  all  know, 
there  are  various  theories  as  to  why  tuberculosis 
occurs  in  the  ends  of  long  bones  and  not,  as  a 
rule,  in  the  shaft.  Some  say  the  vulnerability  is 
due  to  the  arrangement  of  the  blood  vessels — 
that  is,  the  lack  of  anastomosis  in  the  end  ar- 
teries— and  that  small  emboli  of  a  conglomerated 
mass  containing  the  tubercle  bacillus  from  some 
other  focus  lodge  in  the  end  arteries  around  the 
epiphysis  of  long  bones. 

Ely  of  Denver  advances  a  theory  that  it  is  due 
to  the  fact  that  we  find  lymphoid  marrow,  or  red 
marrow,  in  the  end  of  long  bones,  and  this  gives 
a  foothold  for  tuberculosis.  As  there  is  more  red 
marrow  in   the  bones   of  children,  this  explains 


'Read   before   th"    Baltimore  County   Medical    Association, 

.May   I."..   1912. 


why  we  see  more  bone  tuberculosis  in  children 
than  in  adults ;  but  joint  tuberculosis  is  rare  in 
children  under  one  year  of  age. 

The  blood  or  lymph  is  the  medium  through 
which  the  tubercle  bacilli  are  conveyed  to  the 
bone  from  some  other  focus.  It  may  enter  by 
direct  extension.  After  the  tubercle  bacillus  en- 
ters the  bone  it  sets  up  a  low  grade  of  inflamma- 
tion, causing  a  small  spot  of  hyperemia,  probably 
due  to  the  toxin  formed  by  the  organism.  This 
forms  a  small  granulomatous  area  in  which  may 
be  found  the  characteristic  yellow  or  gray  tuber- 
cle, which  may  be  composed  of  one  or  more  giant 
cells  having  several  nuclei,  surrounded  by  a  mass 
of  epithelioid  cells,  and  these,  in  turn,  surrounded 
by  lymphoid  cells. 

This  area  becomes  larger  and  opaque,  and  is 
surrounded  by  a  hyperemic  area  which  spreads 
by  peripheral  extension,  and  results  in  tubercular 
granulation  tissue.  During  the  later  or  reparative 
stage  of  this  process  the  area  becomes  less  vascu- 
lar, and  is  converted  into  a  dense  fibrous  tissue, 
but  in  the  center  of  which  degeneration  and  ne- 
crosis take  place.  This  is  called  caseation.  If 
caseation  takes  place  without  suppuration,  it  is 
called  "caries  sicca,"  but  if  it  takes  place  with 
suppuration  it  is  known  as  "caries  necrotica,"  it 
being  secondary  or  consecutive,  and  will  point  in 
the  line  of  least  resistance,  burrowing  its  way  by 
the  weight  of  the  contents  of  the  abscess,  infect- 
ing the  soft  tissues  as  it  goes,  thus  carrying  the 
tubercular  disease  into  different  parts,  rendering 
the  treatment  of  the  diseased  soft  tissues  equally 
as  hard  as  that  of  the  original  focus. 

An  area  of  caries  necrotica  may  become  walled 
off  and  result  in  a  cloaca  or  become  calcified ;  but, 
as  a  rule,  abscesses  and  subsequent  sinus  forma- 
tions are  frequent  complications,  indicating  the 
destructive  character  of  the  osteitis  and  the  low 
grade  of  resistance  on  the  part  of  the  host.  A 
tubercular  abscess  and  sinus  is  surrounded  by  a 
pyogenic  membrane,  that  is,  a  wall  of  granula- 
tion tissue  filled  with  tubercles  if  the  tissues  are 
vulnerable  to  tuberculosis  and  are  secondarily  in- 
fected ;  if  not,  they  will  not  be  found. 

Bearing  these  points  in  mind,  one  will  be  better 
able  to  treat  tubercular  abscesses  and  sinuses. 
Among  the  various  forms  of  treatment  may  be 
mentioned  the  following:  Evacuation  of  the  ab- 
scess and  immediate  closure ;  evacuation  and 
drainage;  evacuation  and  injection  of  iodoform- 
erlycerine;  evacuation  ami  swabbing  out  with  car- 


THE    HOSPITAL    BULLETIN 


89 


bolic  acid,  followed  by  alcohol ;  washing  out  with 
hydrogen  peroxide  or  40  per  cent,  formalin,  iodo- 
form ether,  zinc  chloride  solution,  tincture  of 
iodine;  evacuation  and  injection  of  Heck's  bis- 
muth paste  or  injection  of  chalk  powder  and 
vaseline;  vaccines  in  mixed  infections,  and, 
finally,  tuberculin  used  both  locally  and  sys- 
temically ;  the  new  tuberculin  used  systemically 
and  the  old  tuberculin  used  in  abscesses  or  sinuses. 

One  will  readily  conclude  from  the  numerous 
methods  here  mentioned  that  the  use  of  any  one 
of  these  has  not  proved  entirely  satisfactory  in 
the  hands  of  orthopedists  in  all  cases.  We  have 
used  all  of  the  above  methods,  but  have  found  by 
experience  that  better  results  are  obtained  by  the 
following'  treatment;  We  must  bear  in  mind  that 
nature  is  engaged  in  a  local,  germicidal  warfare, 
and  well-directed  assistance  in  building  up  the 
general  condition  of  the  patient  will  enable  her  to 
conquer.  Remember  to  treat,  first  of  all,  the  pri- 
mary focus  by  the  best  means  possible,  and  that 
the  treatment  of  the  abscess  is  secondary ;  there- 
fore, not  only  orthopedic,  but  all  hygienic  meas- 
ures must  be  enforced,  such  as  sufficient  sleep. 
fresh  air,  sunlight,  good,  nourishing  food,  proper 
clothing,  etc.  All  of  these  are  most  important 
adjuvants,  but  too  much  stress  cannot  be  laid 
upon  the  importance  of  good  food,  fresh  air  and 
sunlight,  as  these  are  the  most  important  agents 
required  not  only  in  phthisis,  but  in  bone  tuber- 
culosis. 

Other  measures  should  be  employed  to  improve 
the  general  conditions,  such  as  tonics  and  altera- 
tives, which  must  be  selected  according  to  each  in- 
dividual case.  We  have  had  good  results  from 
using  olive  oil,  hypophosphites.  strychnine,  tinc- 
ture of  nux  vomica,  potassium  iodide,  tincture  of 
ferric  chloride  and  syrup  of  the  iodide  of  iron. 

Now,  as  to  local  treatment,  we  have  found  that 
the  existence  of  a  tubercular  abscess  does  not 
necessitate  immediate  evacuation,  so  we  find  that 
the  expectant  treatment,  combined  with  thorough 
mechanical  treatment,  often  yields  good  results. 
If  the  abscess  is  very  large  and  deeply  placed, 
there  being  no  signs  of  pressure  symptoms,  we 
have  found  that  if  the  part  is  put  at  rest  by  trac- 
tion and  fixation,  and  the  patient  allowed  plenty 
of  fresh  air,  sunlight  and  good  food,  the  contents 
of  the  abscess  will  become  absorbed  or  the  case- 
ous material  will  become  encapsulated.  There- 
fore, we  religiously  discourage  immediate  evacu- 
ation of  the  abscess  unless  it  has  signs  of  second- 


ary infection,  because  an  abscess  that  is  opened  is 
not  only  most  prone  to  secondary  infection  by 
pyogenic  cocci  from  the  skin  and  hair  follicles  if 
left  open  for  24  hours,  but  may  cause  a  dissemina- 
tion of  tubercle  bacilli  by  way  of  the  blond  or 
lymph,  setting  up  miliary  tuberculosis  or  menin- 
gitis, or  it  may  cause  the  formation  of  a  sinus 
which  will  probably  not  only  discharge  as  long  as 
the  disease  is  active,  but  is  ''the  gateway  by  which 
death  so  often  enters." 

In  cases  in  which  the  patient  has  a  great  deal 
i/t  pain,  due  to  pressure  on  nerves,  blood  vessels  or 
bowels  or  interference  with  digestive  or  respira- 
tory functions,  we  advocate  incision,  evacuation 
1  >f  the  abscess  and  immediate  closure.  Under  no 
circumstances  do  we  allow  an  abscess  to  be  left 
alone  when  the  skin  is  becoming  reddened  from 
tuberculous  infiltration,  because  it  will  ultimately 
break  down  and  most  likely  become  secondarily 
infected. 

All  abscesses  secondarily  infected  should  be 
opened  at  once,  swabbed  out  with  carbolic  acid, 
followed  by  alcohol,  which  will  destroy  the  re- 
maining tubercular  germs  and  the  secondary  in- 
fection. There  should  be  no  fear  of  absorption 
by  using  pure  carbolic  acid,  followed  by  alcohol, 
for  it  unites  with  the  albuminous  material,  form- 
ing an  albuminoid,  which  is  absorbed  by  the  lym- 
phatics and  destroys  the  bacteria  beyond  the  focus 
of  the  disease. 

In  some  convalescent  cases  of  bone  tubercu- 
losis, where  the  focus  is  circumscribed  and  easilv 
accessible — for  example,  in  the  condyles  of  the 
femur — erasion  may  be  done,  always  by  the  use 
of  an  Esmarch  bandage  and  a  tourniquet.  The 
cavity  is  swabbed  out  with  tincture  of  iodine  and 
filled  with  the  following  mixture:  Yellow  wax. 
one  part ;  lanolin,  five  parts ;  bismuth  subnitrate, 
15  grains  to  an  ounce  of  the  mixture,  after  which 
the  incision  is  closed.  We  believe  this  procedure 
has,  by  direct  extension,  saved  many  joints  from 
infection.  This  does  not,  of  course,  apply  to 
tubercular  foci  within  the  joint  or  vertebrae. 

Secondary  abscesses  recurring  after  once  being 
opened,  avacuated  and  closed  are  opened  the  sec- 
ond time,  evacuated  and  the  cavity  filled  with  a 
mixture  of  precipitated  chalk  powder  and  vase- 
line or  with  Beck's  bismuth  paste.  We  have  had 
good  results  from  most  case--  by  the  use  of  this 
method  of  treatment,  generally  two  or  three  in- 
jections being  necessary. 

There  are  certain  cases,  however,  that  refuse 


go 


THE    HOSPITAL    BULLETIN 


to  heal  under  any  local  treatment,  and  ultimately 
result  in  the  formation  of  an  obstinate  sinus. 
Here  we  have  a  rather  difficult  condition  to  treat, 
but.  again,  we  have  greater  success  by  the  use  of 
Beck's  bismuth  paste  or  by  the  use  of  a  chalk 
mixture ;  but  in  the  use  of  the  former  one  has  to 
be  somewhat  cautious  to  guard  against  bismuth 
poisoning,  although  we  have  had  only  one  case 
poisoned  by  bismuth.  As  some  patients  seem  to 
have  a  marked  idiosyncrasy  for  the  substance,  we 
are  using  the  chalk  mixture  almost  exclusively. 

Lately  we  have  been  using  old  tuberculin 
locally  with  fair  results.  It  is  very  stimulating 
to  the  sluggish  granulations,  and  converts  the 
creamy  pus  into  sero-sanguinous  pus.  After  two 
or  three  injections  the  sinuses  appear  healthy  and 
the  discharge  is  markedly  decreased. 

The  technique  is  very  simple,  and  consists  of 
the  injection  of  about  120  m.  of  1-500  old  tuber- 
culin into  the  depths  of  the  sinus  by  means  of  a 
small,  soft-rubber  catheter,  which  is  then  with- 
drawn as  one  or  more  injections  is  made,  in  the 
endeavor  to  bring  the  tuberculin  into  immediate 
contact  with  the  walls  of  the  sinus. 

After  three  or  four  injections  the  strength  of 
the  tuberculin  is  increased  from  1-500  to  1-250, 
or  even  stronger.  This  is  governed  by  the  reac- 
tion, both  local  and  systemic.  The  injections  are 
given  biweekly.  Generally  there  is  some  systemic 
as  well  as  local  reaction.  Frequently  the  pa- 
tient's temperature  may  reach  101-101.50.  with 
marked  lassitude,  but  this  is  less  marked  after  the 
first  two  or  three  injections,  and  usually  disap- 
pears entirely  after  subsequent  treatments.  Great 
care  must  be  taken  to  prevent  the  use  of  strong 
tuberculin,  as  it  will  cause  a  rise  of  temperature. 

( )ur  feeling  in  the  matter  is  that  the  sooner  we 
get  the  sinus  closed  or  thoroughly  plugged — 
aside  from  the  treatment  of  the  granulations  with 
the  tuberculin,  or  some  other  substance,  to  stimu- 
late the  walls  of  the  abscess  or  sinus — the  better 
it  is  for  the  patient. 
Kernan's  Hospital. 


IN  MEMORIAM 

At  a  meeting  of  the  Regents  of  the  University 
of  .Maryland  on  June  19,  1912,  called  on  the  oc- 
casion of  the  death  of  the  Honorable  Bernard 
Carter,  LL.D.,  the  following  minute  was  adopted 
and  placed  upon  their  records: 


The  Regents  of  the  University  of  Maryland 
deplore  deeply  the  loss  which  the  institution  un- 
der their  charge  and  themselves  personally  have 
sustained  in  the  death  of  the  Honorable  Bernard 
Carter,  LL.D.,  Provost  of  the  University. 

Succeeding  the  late  Severn  Teackle  Wallis 
in  the  office  of  Provost  18  years  ago,  Mr.  Carter 
manifested  during  that  whole  period  the  deepest 
interest  in  the  welfare  of  the  University.  While 
it  would  have  been  natural  that  from  his  own  pro- 
fessional studies  he  should  have  bestowed  his  spe- 
cial thought  upon  the  school  of  law,  in  which  he 
had  been  at  one  time  an  instructor,  yet  in  the  ad- 
mirable addresses  which  he  made  to  the  assem- 
bled classes  of  students  in  the  several  schools  of 
the  University  on  the  commencement  occasions 
he  showed  always  a  full  appreciation  of  the  na- 
ture and  importance  of  their  respective  studies. 

From  his  experience  in  his  own  profession  of 
the  law,  in  which  he  had  attained  the  highest  dis- 
tinction and  had  won  by  the  consent  of  all  and 
enjoyed  for  approximately  a  quarter  of  a  century 
the  position  of  leader  of  the  bar,  he  knew  the  diffi- 
culties and  discouragements  which  the  young 
votaries  of  science  encountered  in  the  early  pe- 
riods of  their  careers.  From  this  knowledge  he 
manifested  by  his  words  and  by  his  looks  a  deep 
and  sympathetic  interest  in  the  students  before 
him,  and  he  showed  them  by  his  wise  counsels 
how  their  trials  were  to  be  met  and  overcome. 
And  thus  his  words  of  encouragement  and  stim- 
ulation seemed  a  benediction  upon  the  work  in 
which  the  young  graduates  of  the  University 
were  about  to  engage. 

From  early  life  Mr.  Carter  had  taken  a  deep 
interest  in  the  work  of  the  church  to  which  he 
was  attached,  and  for  this  reason,  and  especially 
from  his  knowledge  of  ecclesiastical  history  and 
law,  he  was  for  many  successive  years  elected  a 
delegate  to  the  Diocesan  Convention  of  Maryland 
and  on  several  occasions  a  deputy  to  the  Trien- 
nial General  Convention  of  the  Episcopal  Church, 
of  both  of  which  bodies  he  was  always  regarded 
as  a  most  influential  and  valuable  member. 

In  all  of  these  fields  of  labor,  that  of  the  coun- 
cils of  the  church,  that  of  his  own  profession  and 
that  of  the  academic  work  of  the  University  of 
Maryland,  he  was  governed  and  guided  by  his 
earnest  and  devoted  Christian  faith.  As  was  his 
faithful  and  conscientious  labor,  so  be  his  reward. 

Daniel  Base, 

Secretary. 


THE    HOSPITAL    BULLETIN 


91 


THE   HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

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Baltimore,  July  15,  191 2. 


UNIVERSITY    LOSES    HER   PROVOST. 


The  news  from  Xaragansett  Pier,  R.  I.,  June 
13.  H)i2.  that  Bernard  Carter,  Provost  of  the 
University  since  1894,  had  died  suddenly  that 
morning,  was  a  great  shock  to  University  men 
and  Marylanders  in  general.  Mr.  Carter  had  not 
been  well  for  some  months,  but  his  death  was 
wholly  unexpected.  He  had  gone  to  Naragansett 
but  the  day  previous  to  that  upon  which  he  was 
stricken,  and  was  anticipating  a  pleasant  vacation 
there. 

Bernard  Carter  was  born  in  Prince  George's 
county  July  20,  1834,  and  is  descended  from  the 
Carter  family  of  lower  Virginia  and  the  Calvert 
family  of  .Maryland.  His  father,  Charles  Carter, 
was  the  son  of  Bernard  Moore  Carter  and  grand- 
son of  Charles  Carter,  of  Shirley,  on  the  James 
River.  Robert  Carter,  wdio  was  known  as  "King" 
Carter  of  colonial  times,  was  a  direct  ancestor. 
Bernard  Carter  was  a  grandson  of  "Light  Horse" 
Harry  Lee  and  first  cousin  of  Gen.  Robert  E.  Lee. 
His  mother  was  Rosalie  Eugenia,  daughter  of 
George  Calvert,  son  of  Benedict  Calvert,  and 
grandson  of  Charles,  the  sixth  Lord  Baltimore. 
Mr.  Carter  was  also  a  direct  descendant  of 
Rubens,  the  painter,  through  his  great-grand- 
father, Henry  J.  Stier  d'Aertzlaer  of  Antwerp, 
Belgium,  who  tied  to  this  country  in  1784  to  es- 
cape scenes  and  dangers  of  the  French  Revolu- 
tion, but  returned  in  1805,  when  Belgium  was 
annexed  to  France,  to  prevent  the  confiscation  of 


his  large  landed  estates.  His  daughter  married 
( leorge  Calvert. 

Bernard  Carter  graduated  from  St.  James'  Col- 
lege, Washington  county,  Maryland,  in  1852.  re- 
ceiving his  degree  of  master  of  arts  from  that 
school  three  years  later.  He  then  studied  law  at 
Harvard,  where  he  graduated  in  1855.  He  then 
came  to  Baltimore,  and  was  admitted  to  the  bar, 
entering  the  office  of  J.  Mason  Campbell.  He 
always  lived  and  practiced  here,  and  soon  became 
a  leader  of  the  bar  of  the  State.  In  1865  he  was 
admitted  to  the  bar  of  the  Supreme  Court  of  the 
United  States,  his  first  argument  before  that  court 
being  in  the  case  of  the  steamer  "Louisiana,"  re- 
ported in  "Wallace's  Reports."  He  was  always 
a  corporation  lawyer,  having  immediately  after 
his  admission  to  the  bar  evidenced  a  distaste  for 
criminal  suits.  At  the  death  of  J.  Mason  Camp- 
bell he  was  appointed  chief  counsel  of  the  Penn- 
sylvania Railroad  Co.  and  its  subsidiary  branches, 
and  remained  with  it  throughout  its  growth  from 
a  small  local  transportation  line  to  its  present 
influential  position,  waging  its  battles  in  the  local 
courts,  the  Court  of  Appeals,  in  the  Federal,  Dis- 
trict and  Circuit  courts,  and  the  United  States 
Supreme  Court. 

In  1861  he  was  the  nominee  of  the  Democratic 
party  for  State's  Attorney  of  Baltimore,  and  in 
1864  for  Attorney-General  of  the  State.  He  was 
not  elected,  owing  to  the  strong  Republican  trend 
of  those  days.  He  served  in  the  First  Branch  of 
the  City  Council  in  1869  and  1870,  and  as  chair- 
man of  the  Ways  and  Means  Committee  did  much 
toward  the  economical  building  of  the  present 
City  Hall.  In  1867  he  was  a  delegate  from  Balti- 
more to  the  Constitutional  Convention  of  the 
State,  and  through  his  work  at  that  convention 
was  appointed  a  member  of  the  committee  on 
revision  and  compilation,  to  which  were  referred 
all  sections  of  the  Constitution  which  had  been 
adopted  for  arrangement,  revision  and  correction 
before  being  finally  passed  upon.  In  1895  he  was 
counsel  to  the  Board  of  Police  Commisioners.  He 
was  often  urged  to  run  for  Congress,  but 
repeatedly  refused.  Once  he  was  induced,  against 
his  own  better  judgment,  to  be  a  candidate  for 
the  United  States  Senate,  but  failed  of  election. 
He  was  City  Solicitor  from  1883  to  1889,  and 
again  in  1900,  but  only  remained  in  the  office  a 
few  months,  as  its  duties  conflicted  with  those  of 
a  corporation  whose  counsel  he  was. 


92 


THE    HOSPITAL    BULLETIN 


Mr.  Carter  married  April  20,  1858,  Miss  Mary 
IS.  Ridgely,  daughter  of  David  Ridgely,  of  White- 
marsh,  Baltimore  county,  Maryland,  and  had  12 
children,  of  whom  nine,  three  daughters  and  six 
sons,  are  living.  Charles  H.,  Bernard  M.  and 
Shirley  were  associated  in  law  with  their  father; 
John  Ridgely  Carter  is  a  member  of  the  diplo- 
matic service ;  George  Calvert  Carter  entered  the 
ministry  and  is  rector  of  St.  Andrew's  Protestant 
Episcopal  Church  of  Washington,  and  Julian 
Carter  is  a  well-known  real  estate  man  of  Balti- 
more ;  Mrs.  A.  Robinson  White,  of  Relay,  Mrs. 
Ernest  Law,  of  Philadelphia,  and  Mrs.  Arthur 
Lyman  Fiske,  of  New  York,  the  three  daughters, 
are  equally  well  known.  Mrs.  Carter  died  some 
years  ago.  Mrs.  Fiske  and  Rev.  George  Carter 
and  Bernard  M.  Carter  accompanied  their  father 
to  Newport  and  were  with  him  at  the  time  of  his 
death. 

He  was  buried  from  his  Baltimore  home,  1212 
Eutaw  place,  on  Saturday,  June  15,  1912,  at  11 
o'clock.  Services  were  held  at  Old  St.  Paul's 
Church,  of  which  he  was  a  vestryman  and  active 
member,  having  taken  part  in  all  of  the  ecclesi- 
astic discussions  of  the  State,  and  were  conducted 
by  the  rector,  Rev.  Arthur  B.  Kinsolving,  and  the 
rector  emeritus,  Rev.  J.  S.  B.  Hodges.  The  hon- 
orary pallbearers  were  Chief  Justice  J.  Hunter 
Boyd  and  Judge  Henry  Stockbridge  of  the  Court 
of  Appeals,  Chief  Judge  Harlan  of  the  Supreme 
Bench  of  Baltimore,  Judge  John  C.  Rose  of  the 
United  States  District  Court,  Francis  J.  Gowan 
of  Philadelphia,  general  counsel  of  the  Pennsyl- 
vania Railroad ;  Gamble  Latrobe,  general  local 
agent  of  the  Pennsylvania  Railroad,  and  John  J. 
Donaldson,  James  L.  McLane,  Arthur  W. 
Machen,  George  C.  Wilkens,  William  A.  House, 
John  S.  Gittings,  Michael  Jenkins,  Douglas  H. 
Thomas,  William  Shepard  Bryan,  F.  H.  Bethell, 
Dr.  Cary  B.  Gamble,  Jr.,  Robert  Crane  and  Rob- 
ert W.  Johnson.  The  active  pallbearers  were  the 
five  sons  who  were  able  to  be  here  (John  Ridgely 
Carter  being  in  London  at  the  time)  and  a 
nephew,  Carter  M.  Bowie.  Interment  was  in  the 
family  lot  in  Greenmount  Cemetery. 

Bernard  Carter  became  a  professor  in  the  Law 
School  of  the  University  in  1878,  and  in  1895 
became  Provost.  His  lectures  were  noted,  and 
the  University  claimed  him  among  the  many 
"giants"  who  have  honored  her  halls.  A  giant 
in  stature  and  mind,  he  loomed  large  in  the  legal 


horizon  of  his  day.  Entering  the  legal  world,  as- 
he  did,  in  a  day  when  telephones  and  telegraphs 
and  typewriters  were  unknown,  when  the  entire 
profession  of  the  State  numbered  but  about  125, 
and  when  Maryland  was  noted  for  its  able  law- 
yers, he  remained  a  representative  of  that  day 
until  he  died.  Progressing  with  the  progress  of 
the  times,  he  never  lost  his  old-school  manner  or 
his  old-school  method  of  grappling  with  details. 
He  was  always  courteous,  and  his  kindness  to 
timid  witnesses  was  proverbial.  His  self-control 
was  remarkable,  and  he  was  never  known  to  take 
an  unfair  advantage.  He  was  loved  and  revered 
by  the  younger  lawyers  and  looked  up  to  by  all. 

In  politics  he  was  a  Democrat,  and  though  he 
gave  his  time  almost  entirely  to  his  profession, 
occasionally  he  consented  to  use  his  talents  in 
behalf  of  his  party  and  made  several  telling 
speeches  in  favor  of  Democratic  principles. 

Bernard  Carter's  name  has  shed  luster  upon 
the  University,  even  as  the  names  of  Roger  B. 
Taney  and  Severn  Teackle  Wallis  did  in  that 
elder  day  when  they,  as  provosts,  guided  its  des- 
tinies. It  is  fitting  that  the  men  who  stand  at  the 
head  of  our  venerable  institution  should  be,  as 
they  have  always  been,  the  men  at  the  top  rung 
of  Maryland's  bar  and  men  who  are  regarded  as 
the  foremost  citizens  of  the  State  of  Maryland. 
We  await  with  interest  the  appointment  of  Mr. 
Carter's  successor,  and  hope  that  he  will  be  given 
a  freer  hand  in  the  upbuilding  of  the  University. 


THE    STEAM   ROLLER  AND   THE   MED- 
ICAL COLLEGES. 


We  have  heard  much  of  the  steam  roller  as 
applied  to  practical  politics  of  late,  and  Chicago 
has  been  especiallv  prominent  in  the  enforcement 
of  steam-roller  methods  in  the  selection  of  candi- 
dates for  high  governmental  offices.  The  steam 
roller  is  also  being  applied  to  the  medical  colleges, 
with  the  object  of  crushing  out  of  existence  a 
large  proportion  of  those  that  are  now  in  more  or 
less  active  operation.  This  juggernaut  also  oper- 
ates in  and  from  Chicago  through  the  Council  on 
Medical  Education  of  the  American  Medical  As- 
sociation. While  the  methods  are  drastic,  the 
writer  is  not  inclined  to  quarrel  with  the  intent  of 
the  Council,  which  is  to  reduce  the  number  of 
medical  schools  in  the  United  States  about  one- 
half  and  to  improve  those  that  remain.     Among 


THE    HOSPITAL    BULLETIN 


93 


the  edicts  that  have  been  handed  down  is  one  that 
is  in  the  line  of  progress,  though  it  will  doubtless 
inflict  serious  injury  to  many  institutions.  This 
is  a  ruling  passed  at  the  recent  meeting  of  the 
Association  at  Atlantic  City  that  alter  January  I, 
11,114,  all  schools  wishing  to  be  classified  in  Class 
A  must  require  a  year  of  college  work  in  chem- 
istry, biology  and  physics,  with  one  foreign  mod- 
ern language,  in  addition  to  a  completed  four- 
years'  high-school  course.  This  rule  goes  into 
effect  a  year  and  a  half  from  now  ;  hence  time  will 
be  given  to  notify  prospective  students  of  the  in- 
creased requirement.  The  University  of  Mary- 
land will  loyally  comply  with  this  ruling  at  the 
appointed  time. 

The  demand  is  also  made  by  the  various  organi- 
zations that  have  authority  to  do  so  that  the 
laboratory  branches  be  filled  by  full-time,  expert, 
salaried  teachers,  and  our  school  is  now  reorgan- 
izing its  staff  in  such  a  manner  as  to  comply  with 
this  requirement.  This  means  that  the  clinical 
teachers  will  receive  no  salaries,  and  that  the  reve- 
nues of  the  school  will  be  devoted  to  the  scientific 
departments.  The  battle  is  not  always  to  the 
strong  nor  the  race  to  the  swift,  but  it  is  going 
to  be  a  very  bard  matter  for  the  weak  and  the 
slow  medical  schools  to  survive  in  this  struggle. 
The  question  that  concerns  us  is,  Can  we  survive  ? 
We  believe  we  shall,  but  only  by  the  self-sacri- 
ficing labors  of  the  teachers  and  the  financial  aid 
of  our  alumni  and  friends.  We  again  ask  the 
assistance  of  all  of  you  in  raising  the  $100,000 
pathological  fund. 

CONTRIBUTION     BY    CLASSES. 
1848 $50   OO 

1868 10  OO 

1871 35  00 

1872 70  OO 

1873 43o  00 

1874 5  00 

1875 5  00 

1876 115  00 

1877 10  OO 

1880 5  00 

188 1 250  00 

1882 310  00 

1883 35  00 

1885 235  OO 

1886 IOO  OO 

1888 50  OO 

1889 IOO  OO 

1890 175  OO 


1  8; »-' 1 50  OO 

1893 15  00 

1894 1 35  00 

1895 155  OO 

1896 $2   OO 

I897 80  OO' 

1898 105  OO 

1 891 ) 25  OO 

1900 215  OO 

1901 240  OO 

1902 305  OO 

!9Q3 3'5  00 

1904 145  00 

1 905 2  I  O  OO 

1906 165  00 

1907 1 10  OO 

1908 10  OO 

1909 s  °o 

1910 50  OO 

191 1  Terra  Mariae 3  50 

1912  Club  Latino  Americano 25  00 


Total  subscriptions  to  July  I,  1912.  .$10,056  50 

NEW   SUBSCRIPTIONS  IN  JUNE. 

Dr.  II.  U.  Todd,  190S S10  00 

Dr.  W.  F,  Sowers,  1906  (second  contri- 
bution ) 1  o  00 

Dr.  J.  Holmes  Smith,  Jr.,  1905 10  00 

Dr.  H.  J.  Maldeis,  1903   (second  contri- 
bution)   15  00 

Dr.  Chas.  W.  Famous,  1901 5  00 

Dr.   Nathan  Winslow,   1901    ( third  con- 
tribution)    50  00 


Total $100  00 


WHO  SHALL  IT  BE? 


Whether  the  University  of  Maryland  is  to 
stand  still  or  advance  is  the  momentous  question 
the  answer  to  which  is  awaited  with  bated  breath 
by  alumni,  friends  and  well-wishers.  The  River 
Jordan  must  be  crossed,  the  bridges  of  the  past 
burned  so  that  there  may  be  no  turning  back,  if 
the  venerable  institution  is  to  occupy  its  erstwhile 
commanding  position  among  its  sister-institutions. 

The  question  which  is  at  present  uppermost  in 
the  thoughts  of  the  alumni  is,  Who  shall  be  the 
Moses  to  lead  the  University  of  Maryland  into  the 
chosen  land  and  hold  her  there?  If  words  made 
institutions     of     learning,     we     would     be     well 


04 


THE    HOSPITAL    BULLETIN 


founded :  but  we  know  that  actions  only  count, 
and  that  to  insure  actions  we  must  have  a  leader 
of  broad  mind,  one  endowed  with  the  ability  to 
attract  men.  a  man  vested  with  authority  to  seize 
the  helm  and  guide  the  ship  into  a  safe  harbor. 
The  death  of  Provost  Carter  forces  some  action 
upon  the  University,  and  affords  a  golden  oppor- 
tunity to  once  and  forever  remedy  the  anomaly 
of  an  institution  conducted  by  a  head  without  au- 
thority to  act  for  her  welfare.  If  the  occasion  is 
permitted  to  pass,  and  the  same  old  lines  are  pur- 
sued without  change,  then  those  who  today  hold 
the  destinies  of  the  University  in  trust  will  be  held 
culpable  by  future  generations,  and  their  motives 
will  be  adjudged  as  selfish  and  their  viewpoint  as 
narrow.  The'  question  before  the  L "niversity  to- 
day is  one  which  eliminates  persons  ana  holds  up 
for  view  only  the  interests  of  the  University  and 
her  future,  and  personal  ambitions  and  personal 
losses  alike  must  be  forgotten  and  the  upbuilding 
of  the  University  must  be  the  only  end  sought. 

The  alumni  hope  that  there  are  enough  pro- 
gressives in  the  Board  of  Regents  to  read  the 
reactionaries,  if  there  be  any,  out  of  its  body. 
Rocks  are  ahead  of  us  if  a  change  be  not  effected. 
The  life  of  the  institution  is  hanging  in  the  bal- 
ance. The  predatory  rich  are  exerting  every 
means  to  force  us  to  close  up.  This  is  no  mere 
ranting,  but  an  actuality.  It  is  reported  that  Dr. 
Griffith  Davis,  an  alumnus  of  our  institution,  while 
in  conversation  with  Dr.  Franklin  P.  Mall,  pro- 
fessor of  anatomy  in  the  Johns  Hopkins  Univer- 
sity, said  there  is  room  in  Baltimore  for  two  med- 
ical schools  only,  whereupon  the  following  reply 
was  evoked :  "There  is  only  room  for  one — the 
Medical  School  of  the  Johns  Hopkins  University. 
Let  the  other  schools  combine.  We  (the  Johns 
Hopkins  )  intend  to  crush  them  all."  Such,  fel- 
low-alumni, members  of  the  Faculty  of  Physic, 
members  of  the  Board  of  Regents,  is  the  state  of 
affairs.  We  are  surrounded  by  our  enemies.  Are 
we  going  to  stand  idly  by  and  see  the  good  old 
ship  go  down ''.  Don't  for  one  moment  think  it 
unshakable,  for  it  is  not.  Still,  it  is  hard  to  believe 
that  an  institution  which  turned  out  Carroll,  Blue 
and  Carter  has  reached  the  end  of  its  usefulness. 
As  a  matter  of  fact,  the  University  of  Mankind 
ought  to  be  serving  the  State  and  nation  many 
years  after  all  of  us  of  today  have  been  called  be- 
fore our  Master.  However,  in  order  to  insure 
continued  existence  and  usefulness,  the  Board  of 
Regents  must  do  its  part.    They  must  seize  every 


opportunity  to  advance  the  material  as  well  as 
educational  interests,  and  today  offers  them  an 
occasion  fraught  with  possibilities — the  appoint- 
ing of  a  Provost — a  Provost  in  being  as  well  as 
name.  To  be  or  not  to  be — that  is  the  question ; 
whether  the  University  of  Maryland  is  going  to 
die  a  slow  and  agonizing  death  or  is  to  take  on 
renewed  life  and  vitality  is  the  absorbing  question 
which  is  agitating  the  minds  of  all  true  friends  of 
our  institution.  The  answer  will  be  read  in  the 
name  of  the  man  who  is  appointed  Provost. 


ABSTRACT 


THE  PXEUMOCOCCUS  IX  SURGERY. 
Dr.  Arthur  M.  Shipley,  class  of  1902,  in  a 
paper  read  before  the  Medical  and  Chirurgical 
Faculty  of  Maryland,  April  24,  191 2  (Journal 
A.  M.  A.,  May  25,  1912),,  said: 

"For  many  years  the  pneumococcus  was  looked 
on  as  being  of  interest  only  to  the  internist,  but 
there  is  scarcely  any  tissue  in  the  body  immune  to 
its  attacks  and,  as  a  pus-producer,  it  ranks  next  to 
the  well-known  pyogenic  organisms.  Therefore, 
it  frequently  becomes  the  cause  of  distinctly  sur- 
gical conditions.  Some  of  the  serious  complica- 
tions of  pneumonia,  such  as  empyema  and  abscess 
of  the  lungs,  are  often  due  to  the  pneumococcus. 
Other  conditions  are  thrombophlebitis,  arthritis, 
osteomyelitis,  parotitis,  cholangeitis  and  cholecys- 
titis, mastoiditis,  puerperal  sepsis,  and,  especially, 
pneumococcic  peritonitis.  The  sources  and 
avenues  of  infection  still  remain  uncertain.  The 
peritonitis  may  be  a  part  of  a  general  sepsis,  it 
may  be  secondary  to  an  infection  elsewhere,  or 
it  may  be  primary.  Clinically  the  peritonitis  is 
often  secondary  to  pneumonia.  In  these  cases 
the  weight  of  evidence  is  in  favor  of  the  blood- 
stream as  the  carrier  of  the  infection.  Pneu- 
mococcic peritonitis  must  not  be  confused  with 
lobar  pneumonia  with  referred  abdominal  pains 
and  tenderness.  The  morbid  anatomy  of  this 
type  of  peritonitis  closely  resembles  that  of  the 
pleura  under  like  conditions.  The  pus  is  rather 
characteristic.  It  is  odorless,  yellow  or  yellowish- 
green  and  contains  flakes  of  fibrin.  The  onset  is 
sudden,  with  a  sensation  of  chilliness  and,  per- 
haps, a  rigor.  Diarrhea  often  precedes  the  attack 
and  there  is  great  pain,  vomiting,  prostration, 
leukocytosis,  rapid  elevation  of  temperature,  and 
a  rapid  small  pulse.  Tympanites  is  usually  not 
marked,    the    abdominal    wall    being    rigid    and 


THE    HOSPITAL    BULLETIN 


95 


scaphoid.  A  characteristic  doughy  feel  has  been 
spoken  of.  The  progress  of  the  disease  is  more 
rapid  than  that  of  other  types  of  peritonitis.  The 
prognosis  is  extremly  grave,  few  patients  having 
recovered.  The  treatment  is  that  for  suppurative 
peritonitis — nothing  by  mouth,  rapid  operation. 
little  anesthetic,  pelvic  drainage  and  normal  salt 
solutii  in  by  the  rectum. 


ITEMS 


We  are  indebted  to  Old  Maryland  for  the  fol- 
lowing  locations  of  the  class  of  191 2  in  as  far  as 
is  at  present  known  : 

Hebrew  Hospital — Benjamin  Newhouse,  path- 
ologist;  David  Silberman,  assistant  resident  sur- 
geon: Harry  Herman  Rich,  assistant  resident 
physician. 

Springfield,  Mass. — Henry  Zimmerman. 

Santiago,  Cuba — Gerardo  Vega. 

Sudlersville,  Md. — Charles  L.  Joslin. 

Beatrice,  Ala. — Clarke  J.  Stallvvorth. 

Annapolis.  Md. — Roger  V.  Parlett. 

Laurel,  Del. — William  T.  Chipman. 

Windsor  Locks,  Conn. — Daniel  H.  Lawler. 

Ansonia,  Conn. — Edward  H.  J.  Hennessey. 

Bay  view  Hospital — John  A.  Skladowsky  and 
Henry  Diebel,  resident  physicians,  insane  depart- 
ment ;  R.  Bruce  Patrick,  resident  surgeon ;  E.  A. 
Sherrill  and  George  C.  Battle,  tuberculosis  de- 
partment. 

Municipal  Tuberculosis  Hospital — W.  Howard 
Yeager.  chief  resident  physician. 

Homeopathic  Hospital — James  A.  Duggan,  res- 
ident physician. 

Marine  Hospital — John  C.  Stansbury. 

Presbyterian  Eye,  Ear  and  Throat  Hospital — 
Edwin  V.  Whitaker. 


We  are  asked  to  publish  the  following  report 
of  the  receipts  and  expenses  of  the  smoker  given 
by  the  Adjunct  Faculty  to  the  graduating  class  of 

Received  from  members  of  the  Faculty.  .$100  oo 
Disbursed : 

To  caterer $71  40 

Music 12  oo 

Cigars,  postage  and  incidentals.  .      16  60 

Total $ioo  00 


The  engagement  is  announced  of  Dr.  James 
1  fugh  Bay,  class  of  1908,  of  Havre  de  Grace,  Md., 
to  .Miss  Mary  Barton  Saulsbury,  University  I  fos- 
pital  Training  School  for  Nurses,  class  of  I  (joy, 
of  Baltimore,  Md.  Miss  Saulsbury  is  a  daughter 
of  the  late  Dr.  and  Mrs.  Thomas  Bascom  Sauls- 
bury, of  the  Eastern  Shore,  and  a  sister  of  Mrs. 
William  G.  Pugh  of  Govanstown,  Md.  Dr.  Bay 
is  a  son  of  Mr.  and  Mrs.  Thomas  A.  Bay,  Jarretts- 
ville,  Harford  county.  Maryland.  The  marriage 
will  take  place  in  the  early  fall. 


Dr.  Charles  Alfred  Goettling,  Jr.,  class  of  1.910, 
is  located  at  Denmore  Park,  Baltimore,  Md. 


Dr.  William  Douglas  James,  class  of  18S1,  is 
located  at  East  Brady,  Pa. 


Dr.  Ernest  L.  Griffith,  class  of  1907,  is  located 
at  311^2  10th  street,  Huntington,  W.  Ya. 


Dr.  Charles  O'Donovan,  class  of  188 1,  received 
the  degree  honoris  causa  of  LL.D.  from  Loyola 
College. 


Dr.  Archibald  A.  Chisolm,  class  of  1897,  is  the 
only  alumnus  located  in  Newfoundland.  He  is 
at  Manuels,  Harbor  Main,  Newfoundland. 


Dr.  Randolph  Winslow  and  his  daughter,  Miss 
Eliza  Winslow,  sailed  for  Panama  July  13. 


The  new  internes  at  the  University   Hospital 
assumed  their  duties  July  1. 


So  far  as  we  are  able  to  trace,  there  are  but  two 
alumni  of  the  University  located  in  Idaho.  They 
are  Dr.  Joshua  T.  Price,  class  of  1868,  Ilo,  Lewis 
county ;  Dr.  William  M.  Mitchell,  class  of  1905, 
Weiser,  Washington  county. 


The  Alumni  Athletic  Association  has  elected 
the  following  officers  for  the  ensuing-year: 

President — Dr.  Nathan  Winslow.  class  of  1901. 

Yice-President  —  Dr.  Charles  E.  McCormick 
(  Pharmaceutical  Department). 

Secretary  —  Dr.  George  M.  Settle  (Adjunct 
Faculty). 

Treasurer  —  Dr.  Robert  L.    Mitchell,  class  of 

Board  of  Directors — Medical :   Dr.  I.  J.  Spear, 


96 


THE    HOSPITAL    BULLETIN 


class  of  igoo;  Dr.  Robert  P.  Bay,  class  of  1905. 
Law :  Mr.  Cyril  Hansell,  Mr.  James  W.  Bowers. 
Pharmaceutical :  Dr.  Daniel  Base,  Dr.  Charles  E. 
McCormick.  Dental:  Dr.  B.  M.  Hopkinson,  class 
of  1885  (Medical  School);  Dr.  Clyde  V.  Mat- 
thews. 

Manager  Football  Team — E.  Holt  Stevens,  823 
North  Fulton  avenue. 

Manager  Basketball  Team  —  H.  H.  Warner, 
1009  Madison  avenue. 

Advisors  to  Teams  —  Football :  Robert  L. 
Mitchell  (1905),  R.  G.  Willse  (1909),  Frederick 
H.  Vinup  (1909).  Baseball:  YV.  H.  Smith 
(1900),  R.  G.  Willse  (1909),  Robert  P.  Bay 
(1905).  Basketball:  H.  M.  Robinson  (1909), 
Homer  U.  Todd  (1908),  G.  M.  Settle  (Adjunct 
Faculty). 


Col.  Louis  M.  Maus,  U.  S.  A.,  class  of  1874, 
and  Capt.  Perry  L.  Boyer,  U.  S.  A.,  class  of  1899, 
are  located  at  Chicago. 


Dr.  Ernest  Zueblin  of  Pittsburgh  was  a  recent 
visitor  to  the  University  Hospital. 


The  following  alumni  were  present  at  the  ban- 
quet of  the  Alumni  Association  of  the  University 
of  Maryland  School  of  Medicine  at  the  Caswell 
June  1,  1912:  Drs.  Win.  H.  Pearce,  Henry  H. 
Weinberger,  John  I.  Pennington,  FT.  J.  Hill,  Ran- 
dolph Winslow,  J.  R.  Winslow,  Leonard  J.  Tur- 
lington, Wm.  E.  Wiegand,  A.  Trego  Shertzer. 
John  W.  Linthicum,  H.  Louis  Naylor,  E.  M.  Reid, 

A.  D.  McConachie,  W.  R.  Eareckson,  Geo.  A. 
Fleming,  H.  C.  Silver,  W.  S.  Love,  S.  R.  Waters, 
C.  R.  Winterson,  V.  L.  Norwood,  H.  C.  Houck, 
Wm.  J.  Coleman,  A.  L.  Kirk,  James  H.  Wilson, 
H.  C.  Davis,  Joseph  Gichner,  J.  Tyler  Smith,  John 
Houff,  B.  M.  Hopkinson,  C.  Urban  Smith,  W.  A. 

B.  Sellman,  Nathan  Winslow,  G.  Lane  Taneyhill, 
Chas.  E.  Sadtler,  S.  Demarco,  Howard  Kahn, 
Eugene  F.  Cordell,  H.  E.  Zepp,  H.  H.  Biedler,  A. 
Carroll,  W.  F.  Sowers,  H.  J.  Maldeis,  II.  A.  Nay- 
lor, James  H.  Jarrett,  H.  M.  Robinson,  Geo.  H. 
Stewart,  Joseph  T.  Smith,  P.  S.  Fuld,  J.  H.  Reh- 
berger,  F'R.  Winslow,  W.  B.  Kirk,  Louis  B. 
Henkel,  Jr.,  G.  Carroll  Lockard,  James  T.  King. 
M.  C.  Freilinger,  E.  H.  Kloman,  James  M.  Craig- 
hill,  John  II.  Robinson,  Robert  P.  Bay,  Hiram 
Woods,  Edw.  M.  Wise,  Ceo.  S.  M.  Kieffer. 


Rt.  Rev.  Luther  B.  Wilson,  M.D.,  class  of  1877, 
formerly  a  bishop  in  the  Methodist  Episcopal 
Church  in  Philadelphia,  has  been  transferred  to 
New  York  city.  His  headquarters  will  be  150 
Fifth  avenue. 


Rev.  Lynn  Harold  Hough,  in  speaking  at  the 
alumni  banquet  of  the  Medical  School  at  the  Cas- 
well, June  1,  said  in  part: 

"One  way  in  which  to  measure  a  man 
is  by  his  physical  vigor  and  efficiency.  I  am  not 
forgetting  that  a  great  deal  of  the  world's  work 
had  been  done  by  her  invalids.  But,  on  the  whole, 
the  man  physically  fit  has  the  truest  outlook  and 
the  best  opportunity.  The  man  who  is  in  the 
right  bodily  condition,  other  things  being  equal, 
will  run  the  farthest  and  think  the  most  clearlw 
Your  profession  stands  for  keeping  people  phys- 
ically at  their  best.  When  the  physician's  mil- 
lennium comes  we  will  not  send  for  doctors  simply 
when  we  are  sick ;  we  will  have  them  examine  us 
periodically  to  keep  us  well. 

"The  second  method  by  which  you  can  measure 
a  man  is  his  strength  of  mind.  It  is  the  tempta- 
tion of  a  man  in  any  profession  to  become  en- 
grossed in  the  routine  of  his  daily  work  and  to  let 
the  advance  guard  of  the  profession  sweep  by  him. 
But  the  man  who  measures  up  to  the  standards  of 
his  calling  will  read  the  great  journals  of  his  pro- 
fession. He  will  know  what  the  men  who  are  its 
leaders  are  about.  He  will  follow  the  story  of 
what  experimenters  in  laboratories  across  the 
ocean  are  doing.  He  will  be  a  constant  student  of 
the  literature  of  his  line  of  work.  This  is  to  jus- 
tify that  fine  old  phrase  which  called  the  practice 
of  medicine  a  learned  profession.  And  in  all  this 
the  power  of  a  man's  mind  is  enlarged,  the  grasp 
of  his  intellect  is  increased,  and  the  instruments 
of  his  thought  become  more  sharp  and  effective. 
So  using  his  mind,  he  approximates  the  standard 
in  respect  of  this  way  of  measuring  a  man. 

"Another  test  of  a  man  is  the  power  of  his  per- 
sonality. Here  are  two  men.  One  knows  as 
much  as  the  other.  But  one  has  a  vivid,  magnetic 
personality.  He  makes  himself  felt  by  the  sheer 
force  of  personal  vitality.  He  is  the  man  who 
wins.  You  may  feel  very  scornful  about  the  Em- 
manuel movement,  and  you  have  a  right  to  do  it. 
But  there  is  this  much  truth  in  the  movement: 
A  man  who  has  a  hearty,  vital,  vigorous  person- 
ality adds  an  intangible  but  very  valuable  some- 
thing to  the  power  of  the  medicine  he  prescribes. 
The  contagion  of  a  life  full  of  wholesomeness  and 
health  is  of  real  value  in  the  sickroom.    The  phv- 


THE    HOSPITAL    BULLETIN 


97 


sician  who  lias  a  potent,  commanding  personality 
adds  very  much  to  his  other  powers. 

"The  last  standard  I  want  to  suggest  for  the 
measure  of  a  man  is  reverence.  You  can  tell  a 
great  deal  about  a  man  by  what  he  reveres  and 
how  much  he  reveres  it.  Dr.  Oliver  Wendell 
Holmes,  that  brilliant  and  genial  physician  and 
in  iet.  once  said,  'There  is  a  little  plant  called  rev- 
erence in  my  soul's  garden  which  I  like  to  have 
watered  about  once  a  week.'  The  only  thing  the 
matter  with  this  remark  is  that  if  the  plant  is  to 
he  kept  alive  it  really  needs  water  more  than  once 
a  week. 

"There  is  a  type  of  reverence  which  is  based  on 
ignorance.  It  knows  little  of  the  bad  of  life.  It 
knows  little  of  the  hard  and  brutal  facts  of  the 
world.     It  has  a  childish,  innocent  reverence. 

"There  is  another  kind  of  reverence  more  im- 
pressive and  more  comanding.  Here  is  a  man 
who  has  looked  life  full  in  the  eye.  He  has  been 
struck  down  once  and  again  by  hard  and  disil- 
lusioning facts.  He  knows  the  worst  of  life,  and 
heavy  lines  of  experience  and  struggle  have  come 
on  his  face.  It  is  the  face  of  a  warrior,  a  veteran 
in  life's  fight.  But  his  eyes  still  gleam  with  noble 
reverence.  Although  he  knows  the  world,  he  has 
not  become  bitter,  he  has  not  become  a  cynic.  He 
is  a  man  of  noble  confidence,  though  again  and 
again  he  has  faced  the  worst  of  life. 

"No  group  of  men  have  a  better  opportunity  to 
develop  this  virile  reverence  than  the  men  who 
follow  the  medical  profession.  I  feel  like  congrat- 
ulating you  on  your  profession  and  on  the  con- 
tribution you  can  make  to  the  life  and  health  of 
the  world." 


Dr.  Page  Edmunds,  class  of  1898,  was  elected 
vice-president  of  the  Baltimore  &  Ohio  Associa- 
tion of  Railway  Surgeons  at  its  twenty-second  an- 
nual meeting  held  in  Philadelphia  June  i,  1912. 
Dr.  Edmunds  read  a  paper  on  "Supra-Pubic 
Prostatectomv." 


Dr.  S.  W.  Hammond,  class  of  1905,  is  located 
at  123  West  King  street,  Martinsburg,  W.  Va. 


Dr.  Clifton  Norwood  DeYilbiss,  class  of  1910, 
formerly  a  resident  in  the  University  Hospital,  is 
located  at  Laytonsville,  Md. 


Dr.  Joseph  Connor  Joyce,  class  of  1908,  is  lo- 
cated at  Arnold,  Anne  Arundel  county,  Marvland. 


As  far  as  known,  all  of  the  members  of  the 
class  of  1912,  University  Hospital  Training 
School  for  Nurses,  have  taken  up  private  nursing. 


Dr.  Alexander  C.  Abbott,  class  of  1884,  of  Phil- 
adelphia, Pa.,  and  Dr.  John  S.  Fulton,  class  of 
i88r,  of  Washington,  D.  C,  are  members  of  the 
Committee  of  One  Hundred  on  National  Health 
of  the  American  Association  for  the  Advancement 
of  Science. 


Dr.  T.  Morris  Chaney,  Jr.,  class  of  1906,  of  Old 
Fort,  N.  C,  was  a  recent  visitor  to  Baltimore. 


Dr.  William  Cuthbert  Lyon,  class  of  1907,  who 
is  spending  his  honeymoon  abroad,  writes  us 
from  Berlin.  June  26,  having  previously  visited 
Paris  and  Venice. 


Dr.  Henry  C.  Ohle,  class  of  1886,  of  1205  W. 
Fayette  street,  who  lost  his  eyesight  through  an 
infection  received  from  pricking  his  finger  while 
operating  two  and  a  half  years  ago,  is  consider- 
ably better,  and  believes  that  he  will  be  able  to 
recognize  his  friends  within  six  months,  and  to 
resume  his  practice.  Dr.  Ohle  has  been  operated 
upon  six  times,  and  after  16  months  of  blindness 
he  is  now  able  to  see  indistinctly,  as  through  a 
maze.  We  sincerely  hope  that  the  present  outlook 
may  be  verified,  and  that  Dr.  Ohle  may  walk 
among  us  again,  seeing  clearly. 


Miss  Mary  E.  Sullivan,  class  of  191 1,  Univer- 
sity Hospital  Training  School  for  Nurses,  is  as- 
sistant superintendent  of  the  University  Hos- 
pital. 


Dr.  Z.  C.  Myers,  class  of  1881,  of  278  W. 
Market  street,  York,  Pa.,  was  operated  on  re- 
cently at  the  University  Hospital.  He  is  re- 
ported to  be  doing  nicely. 


Surgeon  George  Young,  U.  S.  P.  H.  and  M. 
H.  S.,  class  of  1887.  is  stationed  in  Chicago  at 
1 44 1  Clarendon  avenue.  He  is  also  City  Health 
Commissioner. 


Dr.  C.  L.  Jennings,  class  of  ioor>,  is  located  at  Dr.  Robert  P.  Bay,  class  of  1905,  read  a  paper 

332  W,  Monroe  street,  Jacksonville.  Fla.  before  the  meeting  of  the  Maryland  State  Dental 


98 


THE    HOSPITAL    BULLETIN 


Society,  his  title  being  "Early  Diagnosis  of  Oral      has   been   appointed   superintendent   of   the   new 
Tumors."  Havre  de  Grace  (Md.)  Hospital. 


Dr.  Charles  W.  Mitchell,  class  of  1881,  was  a 
classmate  of  Governor  Woodrow  Wilson,  and  was 
overjoyed  when  told  of  his  nomination.  Dr. 
Mitchell  said: 

"This  has  been  a  great  day  for  me,  but  really, 
you  embarrass  me  when  you  ask  me  to  give  you 
an  interview  over  the  outcome  of  the  fight  for 
the  nomination."  But  when  reminded  of  the  fact 
that  he  was  a  classmate  of  the  nominee  he  began 
bv  paving  a  glowing  tribute  to  Wilson. 

"I  have  been  intimately  acquainted  with  Gov- 
ernor Wilson  for  the  past  35  years,  ever  since 
we  were  college  boys  together,  and  I  am  not  at 
all  surprised  at  his  success,  because  he  possesses 
every  characteristic  and  trait  that  makes  him 
what  was  apparent  to  all  of  us  when  at  college. 

"Yes,  we  graduated  from  Princeton  in  the 
same  class — the  class  of  1879 — and  I  might  add, 
in  passing,  that  another  of  our  classmates  has  only 
recently  been  appointed  by  President  Taft  as  a 
member  of  the  Supreme  Bench  of  the  United 
States.    He  is  Maklen  Pitney." 

Then  turning  to  the  political  situation  in  general 
and  the  achievements  of  Governor  Wilson,  Dr. 
Mitchell  said:  "Politics  in  this  country  has  come 
to  the  parting  of  the  ways,  and  it  is  a  question 
between  the  privileged  classes  and  the  people  at 
large.  I  regard  the  selection  of  Governor  Wilson 
as  the  logical  move  for  the  convention  to  have 
made.  It  is  a  splendid  triumph  for  this  distin- 
guished gentleman,  a  moral  picture  and  the  down- 
fall of  the  machine.  Personally  speaking,  Gov- 
ernor Wilson  is  a  man  of  wonderful  intellectual 
achievements,  absolute  integrity,  splendid  cour- 
age and  unselfish  in  his  devotion  to  the  interests 
of  the  whole  people.  I  do  not  have  the  slightest 
doubt  of  his  election,  and  he  will  make  an  excel- 
lent President.  In  the  face  of  the  nomination  of 
Woodrow  Wilson  there  is  removed  every  possible 
need  or  reason  for  the  organization  of  any  third 
partv,  for  he  embodies  every  ideal  to  appeal  to 
the  people  at  large,  and  I  have  no  doubt  but  that 
many  Roosevelt  followers  will  flock  to  him  on 
election  day." 


Dr.  Herbert  Seth  Anderton,  class  of  19 10,  has 
passed  the  Board  of  Medical  Examiners  of  the 
State  of  California. 


The  following  item  is  clipped  from  The  Star 
of  Wilmington,  N.  C.  Dr.  Bulluck  is  a  graduate 
of  the  class  of  191 1  : 

"It  is  gathered  from  the  State  press  that  Dr. 
Ernest  S.  Bulluck,  a  conspicuously  talented  and 
successful  young  physician  and  surgeon  of  Wil- 
mington, was  the  recipient  of  a  really  signal  honor 
at  the  hands  of  the  North  Carolina  Medical  So- 
ciety recently  in  session  at  Hendersonville.  He 
was  made  vice-president  of  that  august  assembly 
at  a  much  earlier  time  of  life  than  the  honor 
usually  comes  to  the  few  who  attain  it.  It  is  note- 
worthy that  the  society,  composed  as  it  is  of  the 
most  eminent  physicians  and  surgeons  of  the 
State,  should  show  its  marked  appreciation  of 
the  young  men  of  the  profession.  Its  distin- 
guished favor  is  to  be  higly  prized,  and  its  broad- 
ness certainly  is  manifest  in  its  consideration  of 
young  men  of  mark. 

"Young  Dr.  Bulluck  read  before  the  societv  a 
paper  on  "The  Practical  Application  of  Iodine  in 
the  Preparation  of  Patients  for  Operations,"  and 
it  is  observed  that  this  production  brought  forth 
extensive  discussion  and  approval  on  the  part  of 
many  of  the  State's  best-known  surgeons. 

"It  will  be  gratifying  to  the  young  Wilmington 
doctor's  host  of  friends  to  know  this,  and  it  cer- 
tainly gives  pleasure  to  The  Star  to  favorably 
mention  any  of  the  rising  generation  who.  by 
singleness  of  purpose  and  patient  industry,  are 
striving  earnestly  to  attain  mastership  in  the  va- 
rious paths  of  endeavor." 


Miss  Mary   Louise  Gephart,  University  Hos- 
pital Training  School  for  Nurses,  class  of  191 1, 


MARRIAGES 

Dr.  Roscoe  Drake  McMillan,  class  of  1910,  was 
married  to  Miss  Gertrude  Anna  Garrison,  Uni- 
versity Hospital  Training  School  for  Nurses,  class 
of  1910,  at  the  home  of  the  bride,  "Havendale," 
Burgess  Store,  Va.,  June  10,  1912.  Mrs.  Mc- 
Millan is  the  daughter  of  Mr.  and  Mrs.  Lewis 
Ellison  Garrison. 

The  bride  wore  a  gown  of  white  princess  satin 
trimmed  with  princess  lace,  and  carried  lilies  of 


THE    HOSPITAL    BULLETIN 


99 


the  valley  and  roses.  The  maid  of  honor.  Miss 
Genevieve  McMillan,  wore  spangled  chiffon  over 
blue  satin,  and  carried  sweet  peas  and  roses.  The 
bridesmaids,  Misses  Louise  Blundon,  Raphael 
Skinner  and  Florence  Edwards,  wore  gowns  of 
crepe  meteor.  The  best  man  was  Mr.  Kenneth 
Craig  Denny  of  Red  Springs,  N.  C,  and  the 
ushers  Messrs.  Herbert  L.  Garrison,  J.  M.  Mc- 
Callum  and  Howard  Rice. 

The  house  was  decorated  with  daisies  and 
ferns.  The  ceremony  was  performed  by  Rev.  A. 
J.  Reamy,  in  the  presence  of  a  large  number  of 
friends  and  relatives. 

Dr.  and  Mrs.  McMillan  left  immediately  after 
the  wedding  for  Washington,  where  they  will 
spend  a  few  days,  afterwards  motoring  through 
North  and  South  Carolina. 


Dr.  Newton  Webster  Hershner,  class  of  1906, 
of  Mechanicsburg,  Pa.,  was  married  to  Miss 
Wilna  Anna  Landis,  also  of  Mechanicsburg,  on 
Tuesday.  June  18,  1912.  The  couple  will  be  "at 
home"  after  August  1  at  213  West  Main  street, 
Mechanicsburg. 


Dr.  Louis  E.  Langley,  class  of  1910,  of  1129 
Baldwin  street,  Williamsport,  Pa.,  was  married  to 
Mrs.  Nora  L.  Burke  of  Centerville,  Md.,  at  Bal- 
timore, Saturday,  June  29,  1912,  at  10  A.  M.  Dr. 
Langley  is  28  years  of  age,  and  was  a  very  popu- 
lar member  of  the  class  of  1910.  His  first  wife. 
Mrs.  Daisy  E.  Langley,  died  some  years  ago.  Dr. 
Langlev  has  a  son,  E.  Surran  Langley,  five  years 
of  aee. 


Dr.  Harry  Downman  McCarty,  class  of  1905, 
of  613  Park  avenue,  Baltimore,  was  married  to 
Miss  Mary  Maitland  DuBois  of  Ruxton.  Md.,  at 
Baltimore,  June  24,  1912.  Dr.  McCarty  is  a  mem- 
ber of  the  Adjunct  Faculty  of  the  University  of 
Maryland,  and  is  30  years  of  age. 


Dr.  John  Shaw  Gibson,  class  of  1905,  of  Gib- 
son, N.  C,  was  married  to  Miss  Edna  Iona  Ebert, 
daughter  of  Mrs.  Emma  E.  Ebert  and  the  late 
John  W.  Ebert,  on  Tuesday,  June  11,  1912,  at  the 
Second  English  Lutheran  Church  of  Baltimore. 
Only  the  immediate  relatives  of  the  contracting 
parties  were  present.  Dr.  and  Mrs.  Gibson  left 
for  a  sea  trip  to  Boston,  and  will  visit  in  New 
England  and  New  York,  returning  to  Gibson, 
N.  C,  August  1. 


CORRESPONDENCE 

In  Dr.  Howard  A.  Kelly's  Cyclopedia  of  Amer- 
ican Medical  Biography,  the  following  statement 
is  made  with  reference  to  the  life  of  Dr.  Horatio 
Gates  Jameson.  "His  sons  were  all  physicians, 
and  died  leaving  no  descendants."  While  the 
statement  is  absolutely  correct,  we  fear  that  it 
may  be  misconstrued  to  mean  that  there  are  no 
lineal  descendants  of  Dr.  Jameson  now  living, 
which  is  incorrect, as  the  following  communication 
from  his  grandson,  Gen.  Horatio  Gates  Jameson 
Gibson,  U.  S.  A.  (retired),  shows: 

1412  21st  St.  N.  W.,  Wash.,  D.  C,  June  12. 

Editor  Hospital  Bulletin, 

University  of  Maryland,  Baltimore,  Md.: 

In  reply  to  your  letter  of  June  10  asking  infor- 
mation in  regard  to  the  descendants  of  my  grand- 
father, Dr.  Horatio  Gates  Jameson,  I  take  great 
pleasure  in  giving  you  all  the  information  that  I 
have  gathered  in  regard  thereto  in  the  last  30 
years : 

His  sons,  as  you  state,  were  all  physicians,  and 
died  early,  leaving  no  children.  The  last  to  lin- 
ger on  the  scene  was  his  namesake,  who  lived  and 
practiced  his  profession  at  Mt.  Washington,  near 
Haltimore,  for  some  years  prior  to  his  death  in 
1865.  He  married,  but  his  only  child  died  in 
infancy. 

All  Dr.  Jameson's  children  passed  away  some 
years  ago.  Of  their  children  the  following  sur- 
vive:  Catharine  Rebecca  Maze,  Horatio  Gates 
Jameson  Gibson,  George  Fisher,  Emily  Shevell 
Alricks,  Annie  Helen  Latimer,  Robert  Strettel 
Jones  Fisher ;  and  of  the  next  generation  there  are 
living:  Anna  Margaret  Hopkins,  Horatio  Gates 
Gibson  Schissler,  Robert  John  Schissler,  Horatio 
Gates  Jameson  Gibson,  Katharine  Fisher  White, 
Agnes  Gibson  Wallace,  Henry  Kendrick  Gibson, 
Robert  Fisher  Gibson,  Charlotte  Packard  Far- 
quhar,  John  Jameson  Gibson,  Robert  Barry 
Fisher,  Catharine  Fisher,  Helen  Fisher,  Catharine 
Latimer  Ross,  Emily  Latimer,  Jannette  Latimer, 
Robert  Fisher  Latimer,  Catharine  Fisher  Mar- 
shall, Ellen  Mason  Young,  Annie  Marshall  Cole. 
Of  the  next  generation  there  are:  Katharine  Vir- 
ginia Wylie,  William  Hopkins,  James  Herron 
Hopkins,  Katharine  Lispenard  White,  Walker 
Gibson  White,  Arthur  Farquhar,  Robert  Gibson 
Farquhar,  Charlotte  Farquhar.  The  latest  gen- 
eration has :  Andrew  Wylie,  Katharine  Virginia 
Wylie,    Margaret   Wylie,   Craig  Wylie    and   the 


100 


THE    HOSPITAL    BULLETIN 


children  of  Robert  and  John  Gibson,  as  well  as 
those  of  Robert  Barry  Fisher  and  Robert  Fisher 
Latimer,  of  whom  I  have  no  knowledge.  Robert 
Gibson  married  Hattie  McKenney  of  Centerville, 
Md.,  and  John  Gibson  married  twice,  and  both 
have  children. 

My  grandfather's  eldest  daughter,  Cassandra 
Jameson,  married  Rev.  William  J.  Gibson,  and 
had  several  children,  of  whom  only  one  survives — 
Catharine  Rebecca  Maze  of  Carroll,  la. 

My  mother,  Elizabeth  Jameson,  married  Rev. 
John  Gibson,  and  had  several  children.  'William, 
who  became  a  commander  in  the  navy,  married, 
but  had  no  children.  He  wrote  and  published 
"A  Vision  of  Faery  Land  and  Other  Poems," 
"Poems  of  Many  Years  and  Many  Places," 
"Translation  of  the  Poems  of  Goethe,"  reviewed 
and  approved  by  Bayard  Taylor,  Paul  Cams  and 
other  literati.  Horatio  Gates  Jameson,  now  like 
"his  namesake  in  the  Revolution,  "a  general  in 
the  army";  John,  who  became  president  judge  of 
the  19th  judicial  district  of  Pennsylvania;  Rob- 
ert, who  became  a  lawyer,  and  in  1861  joined  the 
army  of  Sterling  Price  in  Missouri,  served  in  the 
"battle  of  Carthage,  and  soon  after  was  stricken 
with  typhoid  fever  and  died ;  William  followed  in 
1887,  and  John  in  1890.  Margaretta  Rebecca 
Mitchell  married  Hiram  Schissler,  and  had  sev- 
•eral  children — Katharine  Chevelle,  Anna  Mar- 
garet, Horatio  Gates  and  Robert  John.  Kath- 
arine married  Frederick  Jean  Nelson,  a  lawyer 
of  Frederick,  Md.,  but  had  no  children.  Anna 
Margaret  married  James  H.  Hopkins  of  Pitts- 
burg, in  Congress  1875-77  and  1883-85,  and  had 
several  children — William,  Katharine  Virginia, 
James  Herron.  William  is  now  a  captain  in  the 
Marine  Corps  of  the  LTnited  States,  and  Kath- 
arine Hopkins  married  Horace  Wylie,  and  had 
several  children — Andrew,  Katharine,  Margaret 
and  Craig.  Margaretta  Schissler  died  in  1879. 
and  Katharine  Nelson  in  1889.  My  mother, 
Elizabeth  Gibson,  died  in  1855.  William  Gib- 
son married  Mary  Dulany  Addison,  but  had  no 
children.  Horatio  Gates  Gibson  married  Har- 
riett Leavenworth  Atkinson,  and  had  several 
children.  Of  these  are  living  Horatio  Gates,  who 
adopted  the  profession  of  his  grandfather  and 
namesake,  and  is  one  of  the  physicians  in  charge 
of  the  New  York  State  Hospital  at  Central  Islip, 
Long  Island,  and  is  often  consulted  as  an  alienist. 
He  married  Elizabeth  McGrann,  but  has  no  chil- 
dren. Catharine  Fisher  Gibson  married  Frank 
Ilullis     White,    and     had    two     children — Kath- 


arine Lispenard  and  Walker  Gibson.  Agnes  Gib- 
son married  George  Weed  Wallace,  but  has  no 
children.  Henry  Kendrick  Gibson  married  Ger- 
trude Davis,  but  has  no  children.  John  Gibson 
of  York  married  Helen  Packard,  and  had  several 
children — Robert  Fisher,  who  is  the  rector  of  the 
Episcopal  Church  in  Williamsport,  Pa.,  ordained 
after  serving  two  terms  as  Mayor'of  York.  Char- 
lotte Packard,  who  married  Frank  Far- 
quhar,  and  has  several  children — Arthur,  Robert 
Gibson  and  Charlotte.  John  Gibson  married 
twice,  and  has  two  children.  He  is  employed  in 
the  Westinghouse  electrical  business  in  Phila- 
delphia. 

Catharine  Jameson  married  Robert  Jones 
Fisher  in  Cincinnati  in  1836  whilst  her  father  was 
president  of  the  Ohio  Medical  College,  and  lived 
the  rest  of  her  days  in  York,  where  her  husband 
was  president  judge  for  30  years.  She  had  sev- 
eral children — George,  Catharine,  Emily  Shevell, 
Annie  Helen  and  Robert  Jones.  George  Fisher 
married  Mary  Barry,  and  had  several  children — 
Robert  Barry,  Catharine  and  Helen.  They  reside 
in  Baltimore.  Catharine  (York)  married  James 
M.  Marshall,  later  a  colonel  in  the  army,  and  had 
several  children — Catharine  Fisher,  Ellen  Mason, 
Annie.  Ellen  married  Dr.  George  Bright  Young 
of  the  U.  S.  Marine  Hospital  Service,  and  has  sev- 
eral children.  Annie  married  Capt.  James  A.  Cole 
of  the  army,  and  has  children.  Emily  Shevell 
married  Levi  B.  Alricks  of  Harrisburg,  but  had 
no  children.  Annie  Helen  married  James  W. 
Latimer,  later  president  judge  in  York,  an  office 
filled  by  three  members  of  the  family,  and  had 
four  children — Robert  Fisher,  Catharine,  Jan- 
ette  and  Emily.  Catharine  Latimer  married 
Brooks  Ross  of  Delaware,  and  has  two  children. 
Robert  Jones  Fisher  married  twice — Harriet 
Tyler  of  Brattleboro,  Vt.,  and  Louise  Martin  of 
Washington — but  has  no  children.  He  was  As- 
sistant Commissioner  of  Patents  under  President 
Harrison,  and  is  now  the  attorney  for  the  Eastern 
Railroad  Association,  and  resides  in  Washington. 

My  grandfather's  second  wife  had  a  son  by  her 
first  husband — Jesse  F.  Ely.  He  is  a  prominent 
business  man  in  Baltimore,  and  as  I  saw  but  little 
of  my  grandfather  after  1840,  you  may  be  able 
to  obtain  some  information  from  him  which  my 
sojourn  in  York,  at  West  Point,  Mexico  and 
California  denied  me  the  opportunity  of  obtaining. 
Very  truly  yours, 

H.  G.  Gibson, 
Brigadier-General,  U.  S.  A.,  Retired. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 
PRICE    Sftl.OO    PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  608  Professional  Building,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.  VIII 


BALTIMORE,  MD.,  AUGUST  IS,   1912. 


No.  6 


AMEBIC  DYSENTERY.11 


By  Roscoe  McMillan*,  M.  D.,  (  1910) 
Red  Springs,  N.  C. 


Historically,  dysentery  is  among  the  oldest  of 
described  diseases,  some  symptoms  and  treatment 
being  known  as  far  back  as  1600  B.  C. 

Hippocrates  was  the  first  to  describe  it  as  an 
infection.  In  regard  to  the  geographical  distri- 
bution, Ayrs  has  commented  on  the  fact  that  "of 
dysentery  it  may  be  said  where  man  is  found 
there  will  some  of  its  forms  appear." 

The  term  dysentery  implies  a  symptom  rather 
than  a  single  pathologic  entity,  but  the  recent 
words  of  Shiga,  Flexner  and  others  render  the 
etiologic  classification  clearer.  The,  old  clinical 
distinction  of  endemic,  epidemic  and  sporadic 
dysentery  hold  good,  as  well  as  those  of  acute  and 
chronic,  and  the  pathologic  varieties — catarrhal, 
ulcerative  and  diphtheretic.  But  the  etiologic 
classification  is  perhaps  the  best. 

First — The  chemical,  as  from  irritating  foods 
and  metals,  such  as  copper,  arsenic,  mercury,  lead, 
etc. 

Second — The  bacterial  or  bacillary,  as  the 
Shiga,  Flexner  and  B.  Pyocyaneus. 

Third — Protozoal,  or  the  amebic  type. 

Lambl,  in  1859,  was  the  first  one  to  offer  the 
suggestion  of  a  specific  cause  for  dysentery. 
Koch,  however,  three  years  before  this  had  de- 
monstrated ameba  from  sections  in  an  ulcerated 
bowel,  showing  a  relationship  between  the  para- 
site and  the  intestinal  lesion.  In  this  country  the 
first  ameba  were  discovered  by  Osier  in  1890,  and 
shortly  after  confirmation  came  from  Stengel  and 
from  various  sources,  and  now  the  disease  has 
been  found  to  exist  scattered  over  many  sections 
of  this  country  and  in  all  parts  of  the  world,  but 
it  is  essentially  a  tropical  or  semi-tropical  disease, 


*Rpad  at  meeting  of  N.  C.  Siate  Medical   Society,   June  IS, 
1912,  llendersouville,  N.  C. 


and  prevails  more  extensively  in  warm  climates 
and  in  connection  with  poorly-drained  soil.  In 
certain  sections  of  the  South,  right  here  in  our 
own  neighborhood,  conditions  are  almost  ideal 
for  the  prevalence  of  this  infection,  so  this  subject 
should  be  one  of  lively  interest.  But,  unfortu- 
nately, it  is  scarcely  regarded  by  the  profession 
in  a  light  at  all  befitting  its  high  importance.  It 
is  a  very  regrettable  fact  that  by  most  physicians 
in  private  practice,  and  even  in  the  best  hospitals 
in  the  Southern  sections  of  the  United  States,  it 
is  not  recognized  as  a  distinct  disease. 

The  records  of  most  of  them — 90  per  cent.  I 
venture  to  say — classify  amebic  dysentery  under 
the  general  term  of  "chronic  dysentery." 

Amebic  dysentery  is  a  colitis,  very  rarely  an 
ilio-colitis,  caused  by  the  ameba  dysenteriae  of 
Councilman  and  LoefHer.  It  is  considered  by  most 
authorities  different  from  the  ameba  found  in  the 
stools  of  healthy  man,  to  which  alone  the  name 
ameba  coli  is  given.  It  would  be  very  interesting, 
did  time  permit,  to  discuss  the  various  views  ad- 
vanced by  pathologists  as  to  the  real  etiologic  fac- 
tor in  these  cases. 

The  parasite  is  water-borne,  or  it  may  be  con- 
veyed by  contaminated  soil  to  the  mouth  by  dirty 
hands,  or  from  eating  green  vegetables  grown  in 
sewage  polluted  ground.  The  parasite  is  from 
15  to  20  m.  diameter,  having  an  outer  zone 
(ectosarc)  which  is  clear,  and  an  inner  zone  ( en- 
dosarc)  which  is  granular.  It  contains  a  nucleus, 
several  vacuoles  and  perhaps  some  foreign  bodies, 
as  bacteria,  blood  cells,  etc.  Its  movement  is  char- 
acteristic. It  moves  by  putting  forth  protrusions 
of  the  ectosarc  in  various  directions,  for  a  time  not 
changing  its  location ;  then  presently  the  endosarc 
gushes  forth  into  an  unusually  long  protrusion, 
and  the  ameba  move  across  the  slide. 

The  essential  feature  of  the  disease  is  always 
an  ulceration.  Inflammation  of  mucosa  is  more 
or  less  general.  The  submucous  coat  becomes 
edematous ;   there   is  infiltration,  and   this   raises 


102 


THE    HOSPITAL    BULLETIN 


the  mucous  membrane  in  round  patches,  necrosi; 
sets  in  and  the  membrane  sloughs.  The  ulcers 
formed  are  either  round,  oval  or  irregular.  They 
extend  to  various  depths, so  sometimes  perforation 
of  gut  becomes  a  complication.  The  ameba  are 
also  found  in  the  tissue,  around  the  ulcers,  in  the 
lymph  spaces  and  in  small  blood  vessels.  Ab- 
scess of  the  liver  Is  one  of  the  most  serious  com- 
plications, and  this  probably  takes  place  through 
the  portal  vessels. 

The  characteristic  lesions  of  the  disease  are 
always  found  in  the  large  bowel,  and  the  gener- 
ally accepted  belief  is  that  the  primary  site  of  in- 
fection is  in  the  cecum,  whence  the  infection  is 
carried  by  natural  forces  throughout  the  colon 
and  rectum.  It  is  claimed  by  some  that  the  distal 
portion  of  the  ileum  is  sometimes  involved,  but 
this  is  denied  by  the  best  authorities. 

The  symptoms  do  not  differ  much  from  those 
due  to  ulceration  of  intestine  from  other  causes. 
Loose  stools,  discharges  of  mucus,  pus  and  blood, 
tenesmus,  abdominal  distension,  loss  of  appetite, 
strength  and  flesh,  and  a  progressive  anemia. 
But  these  are  not  always  constant  or  clearly  de- 
fined. 

The  disease  is  essentially  a  chronic  one,  and  oc- 
casionally during  its  course  there  are  times  when 
the  patient  thinks  he  is  well,  or  great  deal  better, 
as  most  all  of  the  symptoms  have  subsided,  going 
even  so  far  that  patient  may  suffer  somewhat 
from  constipation.  The  parasites  are,  so  to  speak, 
under  cover,  and  soon  break  out  under  certain 
conditions  favoring  a  renewed  activity.  When 
the  diarrhea  occurs  it  does  not  follow  any  set 
rule,  as  great  deal  depends  on  the  location  of  the 
ulcers.  If  they  are  low  down  in  the  rectum, 
there  are  frequent  evacuations,  accompanied  by 
marked  tenesmus.  If  the  lesions  are  in  sigmoid 
or  above  it,  the  movements  may  not  exceed  two 
or  three  per  day.  Mucus  sometimes  is  absent, 
but  blood  or  blood-streaked  mucus  is  fairly  con- 
stant. 

As  I  have  said,  the  symptoms  are  not  always 
constant  or  clearly  defined,  so  a  bedside  diagnosis 
should  not  be  relied  upon  entirely.  By  making 
a  careful  examination  per  rectum  and  by  using 
some  of  the  simple  methods  of  examination,  the 
diagnosis  should  present  no  difficulties.  The 
ulcers  are  characteristic.  They  show  a  tendency 
to  extend  in  direction  of  circular  muscle  fibers 
of  the  gut,  and  they  are  covered  with  white  or 
f'ull  gray  pellicles,  the  removal  of  which  leaves 


a  raw  bleeding  area.  The  miscroscope  should  be 
used,  the  slide  being  warmed  to  body  temperature 
and  specimen  carefully  handled.  The  ulcer  should 
be  scraped  and  should  be  free  from  mucus  and 
fecal  matter,  the  cover  glass  firmly  pressed  down 
on  slide.  When  present,  the  ameba,  with  their 
characteristic  movement,  is  sufficient  for  diag- 
nosis. 

Leucocytosis  is  always  present,  and  is  in  pro- 
portion to  the  severity  of  the  disease. 

The  diagnosis  and  treatment  is  of  utmost  im- 
portance. The  utter  hopelessness  of  a  great  num- 
ber of  cases  is  clue  to  their  being  allowed  to  drag 
on  until  they  yield  to  no  treatment  at  all.  The 
actual  sources  of  infection  are  numerous,  so  pro- 
phylaxis becomes  a  complicated  problem  and  its 
scope  beyond  the  prescribed  limits  of  this  article, 
but  I  do  want  to  emphasize  hygienic  and  sanitary 
measures.  The  first  in  regard  to  the  patient. 
This  includes  fresh  air,  sunshine  and  cheerful 
surroundings.  In  some  cases  change  of  climate 
may  be  helpful,  especially  through  its  effect  on 
the  general  health.  The  sanitary  measures  in  re- 
gard to  those  in  close  proximity  to  patient.  In- 
struct the  nurse  or  attendant  upon  the  absolute 
necessity  of  destroying  all  discharges  from  the 
bowel  and  cleansing  hands  after  waiting  on 
patient.  The  infectious  agent  is  probably  in  the 
main  water-borne,  and  the  danger  of  contaminat- 
ing the  water  supply  should  be  carefully  ex- 
plained. 

Second — Rest   is  always  of  great  importance. 

Third — Diet.  For  a  few  days  it  is  well  to 
restrict  him  to  liquids.  Predigested  foods,  pep- 
tonized milk,  soft  toast  and  soft-boiled  eggs  are 
sometimes  well  borne. 

Fourth — Medication  by  mouth.  I  don't  believe 
there  is  any  known  drug  administered  by  the 
mouth  which  will  retain  sufficient  potency  after 
going  through  some  20-odd  feet  of  intestine  to 
have  any  direct  influence  on  the  ameba.  I  am 
fully  aware  that  ipecac  coated  with  salol,  given 
in  large  doses,  is  lauded  by  many  whose  opinion 
is  entitled  to  all  respect,  but,  speaking  generally, 
the  administration  of  medicine  by  the  mouth 
should  be  resorted  to  only  in  the  presence  of  clear- 
cut  indications.  The  routine  administration  of 
any  of  the  so-called  specifics  is  strongly  con- 
demned, but  I  do  believe  that  in  the  beginning 
and  from  time  to  time  a  mild  mercurial  purge 
should  be  given. 

Fifth — Local  Treatment.     Irrigations  per  rec- 


THE    HOSPITAL    BULLETIN 


103 


turn  with  cleansing  antiseptic  solutions  constitute, 
in  my  opinion,  the  main  dependence  in  a  large 
number  of  cases.  A  wide  diversity  of  opinion 
exists  even  here  as  to  the  most  effective  solution 
to  use,  but  solutions  of  quinine  are  most  widely 
approved,  beginning  at  1  to  5000  of  a  body-warm 
solution,  used  twice  a  day  for  a  few  days  and 
gradually  increasing  to  1  to  1000.  At  least  half 
a  gallon  should  be  introduced  before  any  of  it  is 
allowed  to  return.  Later,  as  patient  improves, 
every  other  day  or  twice  a  week  should  be  often 
enough.  This  should  be  kept  up  for  some  weeks 
after  patient  seems  cured,  and  certainly  until 
repeated  examinations  fail  to  reveal  any 
ameba.  The  success  of  this  treatment  depends 
on  certain  details  in  carrying  out  the  irrigations, 
namely,  marked  elevation  of  hips,  insertion  of 
small  rectal  tube  3  or  4  feet  into  colon  and  re- 
taining the  fluid  for  at  least  15  or  20  minutes. 
Other  solutions,  as  boric  acid,  common  salt,  Hy- 
drastis and  silver  nitrate,  have  been  used  and 
recommended  by  some. 

When  the  rectum  is  very  irritable,  a  preliminary 
injection  of  some  anodyne  solution,  as  cocaine 
or  opium,  will  be  required. 

But  in  spite  of  all  I  have  said,  some  cases  do  not 
yield  to  rectal  lavage  of  any  of  the  solutions  I 
have  named,  no  matter  how  thoroughly  used, 
and  in  these  cases  I  think  surgery  offers  a  very 
promising  field.  The  operation  of  choice  is  ap- 
pendicostomy,  in  which  the  caliber  of  the  appendix 
is  used  as  a  means  for  successful  medication  of 
the  large  bowel.  If  for  any  reason  the  appendix  is 
absent  or  has  suffered  disease,  the  cecum  is  the 
next  resort.  The  solutions  for  use  here  are  the 
same  as  used  per  rectum.  LTnderstand,  I  do  not 
claim  this  as  a  curative  procedure,  but  it  does 
offer  in  certain  cases  the  only  possible  means  of 
gaining  access  to  the  ulcers  when  they  are  situated 
very  high  up.  I  will  not  go  into  the  technique 
of  operation,  but  if  it  is  performed  under  proper 
conditions  by  competent  operators,  it  should  give 
no  larger  mortalitv  than  operation  for  appendi- 
citis. The  disease  itself  is  by  no  means  free  from 
danger  to  life,  as  one  single  complication,  such  as 
amebic  abscess  of  liver,  causes  a  far  greater  mor- 
tality rate  than  that  of  appendicostomy. 


REPORT  (  )F  CASE. 


By  Charles  Wesley  Roberts,  M.  D.,   (iqo6) 
of  Douglas,  (la. 


Dr.  Albert  Hynson  Carroll,  class  of  1907,  is 
at  Woods  Hole,  Mass.,  as  the  guest  of  Dr.  Leo 
F.  White,  professor  of  chemistry  at  Clark  Uni- 
versity. 


Mr.  President  and  Gentlemen  of  the 

Eleventh  District  Medical  Society: 

With  your  kind  permission  I  desire  to  invite 
your  attention  to  the  following  case  report,  feel- 
ing that  it  is  one  of  sufficient  importance  and  in- 
terest to  command  your  careful  consideration 
during  the  few  moments  allotted  to  me  on  the 
program.  I  have  given  the  history  and  after- 
treatment  somewhat  in  detail,  and  if  it  proves 
tiresome  to  you  to  the  extent  of  boring,  I  shall 
seek  to  reinstate  myself  in  your  good-will  by 
alluding  to  the  fact  that  it  is  the  lack  of  impor- 
tant detail  in  our  current  literature  and  textbooks 
that  makes  us  search  for  help  in  vain,  authors 
evidently  looking  upon  minute  detail  as  of  trifling 
significance : 

W.  D.  N. ;  age  26;  born  in  South  Carolina; 
family  history  negative  as  affects  this  report. 

Personal  History. — Had  typhoid  fever  when 
16  years  of  age,  lasting  some  two  weeks,  from 
which  he  made  complete  recovery.  Soon  after 
attack  he  weighed  more  than  ever  before  and 
was  in  perfect  health. 

Present  trouble  began  five  years  ago  as  fol- 
lows: After  taking  food  patient  would  have 
formation  of  gas  on  stomach,  and  some  two  or 
three  hours  after  meals  would  have  extreme  col- 
icky pain  in  epigastric  region  of  such  severity  as 
to  require  something  for  relief.  Patient  says  he 
would  take  some  soda  or  drink  water  or  take 
some  food  and  the  pain  would  be  relieved.  This 
pain  was  accompanied  by  tenderness  in  the  epi- 
gastrium, nausea,  but  no  vomiting.  Pain  did  not 
come  after  every  meal,  but  would  usually  have 
at  least  one  attack  during  each  day.  He  rarely 
ever  had  attacks  at  night,  and  does  not  remem- 
ber to  have  had  an  attack  on  getting  up  before 
breakfast. 

Patient  says  that  he  consulted  several  phy- 
sicians for  this  "stomach  trouble,"  and  when  he 
took  medicine  and  was  careful  about  his  diet  he 
would  get  better,  so  that  there  would  be  intervals 
of  weeks  or  months  when  he  was  practically  free 
from  pain.  After  some  three  years  of  suffering 
of  the  above  type  patient  says  he  began  to  have 
pain  radiate  through  to  back  about  the  region  of 
the    eleventh    or   twelfth    dorsal    vertebrae    and 


104 


THE    HOSPITAL    BULLETIN 


around  into  the  left  axillary  region.  Attacks 
were  more  severe  and  produced  such  nausea  as 
to  cause  vomiting,  which  would  usually  relieve 
the  attack.  This  vomiting  was  productive  of 
only  stomach  contents  making  his  teeth  very 
sharp.  Attacks  came  with  the  same  regularity, 
but  usually  about  two  or  three  hours  after  a 
meal.  After  about  a  year  of  this  type  of  suffer- 
ing, during  which  time,  under  treatment  and  diet, 
he  would  get  better,  to  have  a  return  of  symp- 
toms after  intervals  of  partial  reliej,  patient 
says  all  symptoms  became  exaggerated,  pain  was 
more  constant  and  of  such  severity  as  to  cause 
him  to  double  up  in  bed,  and  would  radiate  all 
over  upper  abdomen,  produced  vomiting  more 
often,  and  his  general  health  began  to  fail.  His 
condition  grew  gradually  worse  until  patient  was 
confined  to  bed,  and  for  some  three  months  pre- 
vious to  his  admittance  to  hospital  he  vomited 
every  clay,  after  nearly  every  meal,  and  became 
emaciated,  losing  some  25  or  30  pounds.  On 
one  occasion  patient  vomited  a  large  quantity 
of  clear  blood,  and  says  that  this  was  accom- 
panied by  extreme  weakness.  No  history  of 
dark  or  tarry  stools. 

(  hi  admittance  to  hospital  patient  presented 
the  appearance  of  extreme  emaciation,  was  very 
sallow,  with  hollow  cheeks  and  eyes,  very  pale 
conjunctivae,  and  was  constantly  eructing  gas. 
Physical  examination  revealed  nothing  abnormal 
about  chest,  kidneys,  genitals  or  abdomen  save 
about  epigastric  region.  On  distention  of  stom- 
ach with  a  seidlitz  powder  it  was  found  greatly 
enlarged,  reaching  below  umbilicus  an  inch  or 
more.  Nothing  could  be  palpated  about  the  py- 
lorus, but  patient  complained  of  tenderness  about 
this  region.  Gall-bladder  area  was  negative. 
The  first  day  in  hospital  patient  was  given  full 
diet,  and  he  took  all  that  was  given  him  because 
he  was  extremely  hungry.  There  was  no  pain  or 
vomiting  until  the  second  day,  when  attack  came 
suddenly,  causing  the  vomiting  of  all  solid  food 
taken  the  day  before,  along  with  about  one-half 
gallon  of  sour  fluid  mixed  with  mucus  and  an 
occasional  streak  of  blood.  This  vomited  matter 
when  left  in  a  glass  vessel  for  an  hour  showed 
the  three-layer  formation  seen  in  atonic  dilata- 
tion of  the  stomach  or  retention  of  food  from 
any  cause — i.  c,  solid  food  at  bottom,  a  clear 
area  of  liquid  and  top  layer  of  mucus.  Chemical 
examination  showed  free  hydrochloric  acid  and 
no    lactic    acid.       Microscopic    examination    re- 


vealed an  abundance  of  yeast  cells.  After  vom- 
iting the  patient  was  relieved  and  ready  for  more 
food. 

A  Saltzer-Ewald  test  meal  gave  the  following 
findings :  Free  hydrochloric  acid,  30 ;  total 
acidity,  50 ;  no  lactic  acid.  Some  three  days  later 
a  second  test  meal  was  examined  and  gave  about 
the  same  findings.  Urine  examination  showed 
no  albumen,  sugar  or  bile.  Hemoglobin  was  be- 
tween 50  and  60.     Patient  weighed  115  pounds. 

Now,  the  history  in  this  case  and  findings 
after  admittance  to  hospital  pointed  very  defi- 
nitely to  pyloric  obstruction,  and  it  was  fair  to 
presume  that  this  obstruction  came  from  a  healed 
or  partially  healed  gastric  ulcer.  The  sallow  ap- 
pearance of  the  patient  led  us  to  suspect  gall- 
bladder involvement,  but  careful  examination 
showed  no  evidence  of  such  complication,  and 
on  further  questioning  of  the  patient  we  learned 
that  this  was  a  family  characteristic,  exaggerated 
in  this  case  by  the  marked  anemia. 

To  sum  up  the  history,  we  have  the  following: 
A  slowly-developing  stomach  trouble,  with  inter- 
vals of  relief,  followed  by  another  onset,  and 
finally  vomiting,  causing  temporary  relief,  then 
vomiting  of  blood — a  chain  of  symptoms  point- 
ing pretty  definitely  to  gastric  ulcer.  The  find- 
ings after  admittance  to  hospital  showed  posi- 
tively that  the  patient  had  pyloric  obstruction, 
and  the  test  meals  led  us  to  exclude  from  the  case 
the  question  of  cancer  as  a  cause.  The  finding 
of  blood-streaked  mucus  and  a  constant,  rather 
high  free  hydrochloric  acid  content  argued  in 
favor  of  an  active  ulcer. 

Exploratory  laparotomy  was  advised  and  read- 
ily accepted.  LTnder  ether  the  upper  abdomen 
was  opened  through  the  right  rectus,  the  gall- 
bladder palpated  and  found  free  from  adhesions, 
compressible  and  without  stones.  Ducts  nega- 
tive. Head  of  pancreas  enlarged,  but  not  woody- 
hard,  rather  giving  the  sensation  of  an  edema- 
tous condition.  On  retracting  the  abdominal 
walls  a  large  scarlike  area  involving  the  pyloric 
end  of  the  stomach  came  into  view.  The  entire 
ring  of  the  pylorus  was  involved  in  a  thick,  rather 
hard  mass,  not  permitting  any  penetration  of  the 
pyloric  opening.  No  active  ulcer  condition  as 
evidenced  by  a  crater-like  feel  in  any  part  of  this 
scarlike  area  could  be  made  out,  but  the  mass 
seemed  to  be  simply  an  edematous  infiltration  of 
the  pylorus,  with  a  very  evident  scar  showing  in 
the  wall  and  extendins:  well  around  the  stomach 


THE   HOSPITAL   BULLETIN 


105 


near  the  pyloric  end.  Several  small  glands  were 
noted  about  the  mass  and  in  the  meso-colon  of 
the  transverse  colon. 

Posterior  gastroenterostomy  was  decided 
upon  as  an  operative  measure  for  relief  and  rap- 
idly performed  by  the  suture  method  without 
clamps,  making  an  anastomotic  opening  of  some 
two  and  one-half  inches  between  the  posterior 
wall  of  the  stomach  and  the  first  part  of  the 
jejunum. 

Patient  was  put  to  bed  in  the  Fowler  sitting 
posture,  which  was  maintained  throughout  the 
convalescent  period.  Normal  saline  proctocylsis 
begun  at  once  and  kept  up  at  intervals  for  three 
days.  Soon  after  being  returned  to  bed  patient 
vomited  small  quantity  of  dark  fluid.  This  was 
the  last  vomiting,  there  being  no  more  while  in 
hospital,  nor  any  since  being  discharged. 

The  convalescent  period  was  absolutely  un- 
eventful, patient  being  allowed  warm  water,  one 
ounce  at  a  time,  the  first  night  after  operation, 
the  quantity  subsequently  gradually  increased. 
Liquid  nourishment  was  given  the  second  day 
and  semi-solid  diet  the  fifth  day.  At  the  end  of 
the  first  week  after  operation  patient  was  taking 
a  fairly  full  diet.  On  the  morning  of  the  third 
day,  following  a  dose  of  castor  oil  the  night  be- 
fore, patient  had  a  good  bowel  movement,  con- 
taing  considerable  dark,  disorganized  blood — a 
typical  tarry  stool.  There  were  no  abnormal 
stools  after  this.  Wound  healed  primarily,  and 
the  patient  was  allowed  out  of  bed  on  the  elev- 
enth day  and  was  discharged  on  the  eighteenth 
day  following  operation. 

There  was  absolute  and  immediate  relief  of 
all  symptoms,  and  the  result  has  been  so  gratify- 
ing that  I  have  had  Mr.  Norton  come  down  with 
me  that  you  might  see  him  and  ask  any  questions 
that  may  interest  you.  It  is  now  some  four 
months  since  the  operation,  and  patient  has  re- 
mained well  and  free  from  symptoms  and  has 
gained  about  40  pounds. 


A     CASE     OF     SIX     MONTHS'    MISCAR- 
RIAGE   INDUCED    BY    MEASLES 
AND    COMPLICATED    BY 
TUBERCULOSIS. 


The  announcement  is  made  that  Dr.  Eugene 
Bascom  Wright,  class  of  1909,  will,  on  Septem- 
ber 1,  succeed  Dr.  Chadbourne  Andrews  as  su- 
perintendent of  the  Hebrew  Hospital,  a  position 
held  for  several  years  by  Dr.  Charles  Bagley, 
Jr.,  class  of  IQ04.  Dr.  Wright  was  for  several 
years  resident  physician  at  the  Church  Home  and 
Infirmary,  and  on  September  2,  1911,  succeeded 
Dr.  Don  Peters  as  superintendent. 


Written  and  Attended  by  Chas.  W.  Rauschen- 
isach.  Senior  Student,  Under  the  Guidance 
of  E.  H.  Kloman,  Ph.  G.,  M.  D.,  Associate 
in  Abstract. 


This  case  is  brought  to  the  attention  of  the 
readers  of  the  Hospital  Bulletin  because  of  the 
rarity  with  which  such  a  condition,  as  here  pre- 
sented, i;;.  seen. 

The  probable  cause  of  abortions  in  pregnant 
women  who  are  suffering  with  measles  is  an  acute 
infectious  deciduitis.  Some  writers  believe  that 
the  uterine  contractions  are  caused  by  the  irrita- 
tion of  the  exanthem  as  it  occurs  in  the  mucous 
membrane  of  the  uterus,  this  disturbance  being 
analogous  to  the  fever,  cough,  photophobia, 
coryza,  bronchitis  and  vesical  tenesmus  which 
so  frequently  complicate  the  eruptive  fevers. 
Therefore  we  see  no  reason  why  the  same  ex- 
planation does  not  hold  good  for  abortions  occur- 
ring in  any  of  the  eruptive  fevers,  as  is  given  for 
the  above  mentioned  complications.  The  patho- 
logical "changes  are  marked  by  small  or  large 
inflammatory  changes  in  the  decidua,  and  within 
these  patches  many  different  varieties  of  bacteria 
have  been  found,  but  no  specific  one.  Measles 
will  terminate  the  vast  majority  of  pregnancies, 
and  the  eruption  will  occasionally  be  noticed  on 
the  foetus.  Kaltz  had  eleven  cases  of  measles 
complicating  pregnancy  and  nine  of  these  abort- 
ed. The  usual  percentage  to  abort  in  these  cases 
is  given  as  at  about  75.  The  chief  dangers  in 
the  puerperium  in  these  cases  are  hemorrhage, 
pneumonia,  occasionally  uterine  sepsis,  and  the 
double  danger  of  the  lighting  up  of  some  old 
tubercular  area  by  the  combined  drain  of  preg- 
nancy and  measles. 

The  patient  is  a  primiparous  colored  girl. 
of  good  physique  and  stature,  and  19  years 
of  age.  Her  menses  first  appeared  at  the  age 
of  13,  had  been  regular,  lasting  four  to  five  days, 
and  unassociated  with  pain. 

Her  family  history  is  absolutely  negative  as 
to  the  bearing  on  this  case.  Her  past  history  is 
negative,  except  that  she  has  had  all  the  symp- 
toms of  a  pulmonary  tuberculosis   for  the  past 


io:> 


THE    HOSPITAL    BULLETIN 


five    months,    viz.,    night    sweats,    coughs    and 
flushes  of  heat. 

Her  general  physique  is  good  and  her  muscu- 
lature firm  and  well  developed.  She  shows  no 
signs  of  any  other  disease,  but  her  pelvis  is  slight- 
ly generally  contracted.  Her  pelvic  measure- 
ments are  as  follows : 

Distancia  spinarum 23  cm. 

Distancia  cristarum 25  cm. 

Intertrochanteric 20,  cm. 

Baudeloque 18  cm. 

The  present  pregnancy  was  associated  with  the 
usual  morning  nausea  and  vomiting ;  but  unas- 
sociated  with  any  of  the  special  symptoms  or  com- 
plications, except  that  one  week  prior  to  the  mis- 
carriage she  had  a  severe  vomiting  spell. 

Upon  our  arrival  at  the  house  we  found  the 
patient  in  a  talking  delirium,  lying  upon  a  broken- 
down  bed  in  a  miserable  dirty  back  room,  just 
under  the  roof,  when  the  sun  was  shining  with 
the  temperature  of  a  boiler-room.  In  one  corner 
of  the  room,  lying  upon  a  coal  stove  and  covered 
with  flies,  lay  the  baby,  placenta,  cord  and  mem- 
branes all  attached. 

We  subsequently  learned  that  the  child  had 
been  delivered  18  hours  previous  to  our  arrival, 
by  a  colored  midwife.  As  far  as  could  be  ascer- 
tained, the  delivery  was  normal  and  uncompli- 
cated. As  previously  stated,  the  woman  was 
found  in  a  delirious  state,  with  a  temperature 
of  io3.5°F.,  and  her  measle  rash  well  out  and 
covering  her  entire  body.  As  the  patient's  skin 
was  of  a  very  dusky  hue  they  appeared  as  small 
black  papules,  hard  in  consistency  and  giving  a 
grating  sensation  to  the  hand  when  passed  over 
them.  She  had  a  pulse  rate  of  135  beats  per 
minute,  which  was  of  fairly  good  tension,  small 
volume,  and  well  sustained.  Her  respirations 
were  25  per  minute.  She  also  had  a  very  severe, 
dry,  hacking  cough,  and  had  lain  in  the  same 
muttering  delirium  as  above  described  the  entire 
previous  night ;  her  lochia  was  scanty,  of  the 
characteristic  normal  fleshy  odor,  red  in  color, 
and  contained  no  clots,  membranes  nor  shreds. 
Her  other  genital  and  excretory  organs  were 
normal  and  functioning.  As  we  considered  the 
patient  in  too  serious  a  condition  we  deferred 
further  examination. 

We  immediately  administered  an  ice  sponge, 
t«i  which  she  reacted  fairly  well,  coming  out  of 
her  delirium,  and  for  the  first  time  that  day. 
taking  an  interest  in  her  surroundings.    We  then 


gave  instructions  that  she  be  given  an  ice  sponge 
every  two  hours  until  our  next  visit  unless  she 
went  to  sleep,  when  she  was  not  to  be  disturbed. 
We  also  made  them  take  out  the  windows  in  the 
room  to  afford  better  ventilation. 

The  following  morning  we  found  that  she  was 
still  comatose  and  obtuse,  but  her  delirium  had 
left  her.  She  had  spent  a  very  restless  night, 
but  had  gotten  a  little  sleep.  Her  lochia  had  now 
become  very  scant  and  possessed  a  very  foetid 
odor.  We  now  directed  that  she  continue  to  be 
sponged  and  be  given  a  glass  of  water  even-  two 
hours  while  awake. 

Upon  seeing  the  patient  in  the  evening  of  the 
same  day  she  had  responded  very  nicely  to  our 
plan  of  treatment  her  temperature  being  99.2°  F.. 
a  drop  of  40  F. ;  her  pulse  no,  a  drop  of  25 
heats,  and  her  respirations  remaining  at  25 
per  minute.  Her  greatest  response,  however, 
showed  itself  in  her  mentality,  though  still  being 
a  little  drowsy ;  she  had  not  had  any  further 
delirium,  was  aware  of  her  surroundings  and 
answered  questions  somewhat  intelligently,  tier 
measle  rash  was  now  most  prominent  on  her 
lower  extremities  and,  in  fact,  that  on  her  face 
was  disappearing.  She  had  slept  some  during 
the  day  and  had  eaten,  for  the  first  time  in  48 
hours,  two  pieces  of  toast,  a  soft  boiled  egg,  and 
a  glass  of  iced  tea.  She  had,  however,  developed 
a  most  annoying  complicating  bronchitis  anil 
laryngitis,  which  greatly  added  to  the  distress. 
This  complication  also  aggravated  her  cough 
and  the  continuous  coughing  caused  her  to  have 
a  constant  throbbing  headache.  The  sponges  were 
now  ordered  discontinued. 

The  next  day,  i.  e.,  the  third  day  of  our  treat- 
ment, we  found  that  she  had  not  slept  any  the 
previous  night,  her  bronchitis  had  become  so 
severe  that  she  could  not  talk  above  a  whisper, 
and  she  had  a  remittance  of  temperature  to 
1 02.5 °  F.  Just  what  caused  this  recrudescence 
of  temperature  could  not  be  ascertained.  We 
now  administered  the  following  prescription  to 
alleviate  her  cough,  bronchitis  and  laryngitis: 

Syrupi   Senegae 

Syrupi  Squillae aa  dr.  ii 

Ammonii   Chloridi dr.  i 

Flixiri  Terpini   Hydratis  et 

Herioni oz.  i 

Syrupi    Strobi    Pini    Com- 

positi — q,  s oz.  ii 

She  was  given  a  drachm  of  the  above  every 


THE    HOSPITAL    BULLETIN 


107 


two  hours.  This  seemed  to  lessen  her  cough, 
which  became  moist,  and  cleared  up  her  bron- 
chitis. She  was  stifl  kept  on  a  light  diet,  con- 
sisting of  soft  boiled  eggs,  mutton  broth,  toast, 
and  tea,  either  hot  or  iced.  Just  what  caused  her 
laryngitis  was  not  quite  apparent  to  us,  but  it 
was  our  opinion  that  it  was  tubercular  induced  by 
the  measles  lighting  up  her  tuberculosis. 

On  the  fifth  day  we  deemed  that  the  patient's 
condition  warranted  making  a  physical  examina- 
tion of  her  chest.  Her  chest,  on  inspection,  was 
well  developed,  and  showed  no  evidence's  of 
rachitis  or  emphysema.  The  skin,  covering  it  was 
loose  and  inelastic,  and  the  respirations  apparently 
equal  on  both  sides,  but  increased.  On  palpation 
tactile  fremitus  was  found  to  be  absent,  but  the 
respirations  in  the  upper  left  lobe  were  some- 
what retarded.  Upon  percussion  we  found  al- 
most flatness  in  the  upper  left  lobe  and  slightly 
impaired  resonance  in  the  bases  of  both  lungs 
posteriorly,  apparently  due  to  hypostasis.  On 
ausculation  harsh  tubular-like  breathing  was 
heard  over  the  left  apex,  i.  e.,  the  breathing  was 
loud  in  character,  expiration  harsher  and  longer 
in  duration  than  inspiration;  and  vocal  fremitus 
increased  over  the  same  area.  Numerous  moist 
sibilant  rales  were  heard  throughout  the  chest 
both  on  inspiration  and  expiration,  and  some  of 
a  musical  twang,  in  all  probability  due  to  the 
bronchitis.  Pectoriloquy  was  negative.  We 
next  had  a  sputum  examination  made  and  the 
tubercular  bacillus  was  found  to  be  present. 

The  patient  subsequently  made  fairly  good 
progress  towards  recovery.  Her  temperature 
slowly  descended,  but  she  still  had  her  nightly 
remissions.  Her  pulse  and  respiratory  rates  have 
also  gradually  descended  until  at  present  they 
are  nearly  normal. 

At  the  time  of  discharge,  which  was  ten  days 
after  beginning  treatment,  the  patient  was  able 
to  get  out  of  bed  and  sit  around.  Her  breasts 
were  perfectly  normal,  in  fact  they  never  had 
developed  milk:  her  uterus  well  involuted,  in  the 
pelvis,  and  occupying  its  normal  position ;  her 
lochia  of  a  serous  character,  moderate  in  amount, 
and  normal  odor :  and  all  her  excretory  organs 
functioning.  Finally  she  was  advised  to  go  to 
the  Tubercular  Department  of  Pay  View  Asylum 
by  Or.  Lee,  which  advice,  however,  was  not  ac- 
cepted. 

This  report  is  incomplete  without  the  descrip- 
tion of  her  present  physical  condition,  which  un- 


doubtedly would  show  some  interesting  sequelae ; 
but  as  all  know  the  members  of  her  race  bear 
ever  in  mind  such  instinctive  fear  of  hospitals, 
that  with  all  the  persuasive  powers  we  could 
command  we  were  unable  to  get  her  to  consent 
to  permit  an  examination  at   hospital. 

Child. — The  child  was  a  female,  well  formed 
for  eight  months.  It  weighed  four  pounds  and 
an  ounce,  and  was  33  cm.  long.  There  were  no 
blemishes  upon  its  body,  nor  any  other  evidences 
which  would  tend  to  show  that  the  child  had 
contracted  rubella  from  its  parent.  The  cord, 
placenta  and  membranes  were  perfectly  normal, 
but  small,  and  presented  no  anamolies. 

Resume. — There  can  be  no  doubt  that  the 
patient  had  pulmonary  tuberculosis,  as  the  bacilli 
were  found  in  the  sputum,  nor  any  doubt  that 
she  did  not  have  measles  (but  some  other  exan- 
thematous  disease  simulating  measles)  as  there 
were  six  other  children  in  the  house  afflicted  with 
typical  cases  of  measles.  As  to  just  what  caused 
the  miscarriage  is  all  a  matter  of  probability,  the 
most  likely  cause  being  measles.  Our  whole  treat- 
ment consisted  of  but  simple  palliative  measures 
which  aided  nature  to  combat  the  morbid  con- 
dition and  aid  in  the  elimination  of  the  deleterious 
materials  formed  bv  the  disease. 


Prof.  Randolph  Winslow  received  the  follow- 
ing letter  from  Dr.  Gerardo  Vega,  class  of  1912, 
shortly  before  leaving  for  his  Panama  trip : 
"Dear  Professor: 

"This  is  just  to  tell  you  that  I  have  passed  suc- 
cessfully the  State  Board,  which  was  quite  strong. 
I  never  thought  it  was  so  strong.  I  was  called 
by  the  examiners,  five  in  number,  and  was  con- 
gratulated upon  my  good  preparation,  which 
makes  me  feel  proud  of  my  dear  old  Alma  Mater. 

"About  the  negro  uprising,  I  will  tell  you 
everything  is  quiet  and  safe,  so  if  you  will  kindly 
tell  me  when  you  expect  to  pass  around  here  or 
Santiago,  I  would  like  to  see  you.  Please  remem- 
ber me  to  all  my  dear  professors. 

"My  father  sends  you  his  respects  and  hopes 
to  see  you  when  you  pass  on  your  way  South. 

".My  best  regards  to  all, 

"Your  humble  servant, 

"G.  Vega. 

"Havana  Manique  127." 


io8 


THE    HOSPITAL    BULLETIN 


SEPTIC    SORE    THROAT. 


By  Nathan  Winslow,  M.D. 


During  the  month  of  February  Baltimore  was 
visited  by  an  epidemic  of  sore  throat  which  the 
profession  soon  realized  to  be  of  an  unusual  type. 
Unlike  ordinary  tonsillitis,  it  was  obstinately  re- 
sistant to  treatment,  was  accompanied  in  many 
instances  by  enormous  swelling  of  the  cervical 
lymph  glands,  and  displayed  a  marked  tendency 
to  secondary  involvement  of  distant  structures. 
The  course  and  characteristics  of  the  malady  were 
so  unlike  the  familiar  forms  of  tonsillitis  that  the 
profession  early  realized  it  was  dealing  with 
something  new.  As  the  affection  was  follewed 
by  death  in  some  few  instances,  it  does  not  seem 
amiss  that  the  readers  of  The  Hospital  Bulle- 
tin be  posted  on  its  symptomatology,  apparent 
mode  of  transmission,  treatment  and  complica- 
tions. A  peculiarity  of  the  disease  in  Baltimore, 
as  in  Chicago  and  Boston,  where  similar  epi- 
demics had  already  occurred,  was  its  following 
the  route  of  certain  dairies.  In  this  city  it  was 
observed  that  most  of  the  cases  were  limited  to 
patrons  of  the  Hygeia  Dairy,  and  after  further 
investigation  it  was  learned  that  the  milk  sup- 
plied by  this  dairy  had  not  been  pasteurized  dur- 
ing the  prevalence  of  the  epidemic,  due  to  a  break- 
down in  the  pasteurizing  apparatus.  The  chief 
interest  centering  in  the  malady,  however,  was 
the  number  and  seriousness  of  the  complications — 
enlargement  of  the  cervical  glands  (with  or  with- 
out suppuration),  broncho-pneumonia,  peritonitis, 
pleurisy,  nephritis,  erysipelas,  peritonsillar  ab- 
scess, otitis  media,  endocarditis,  septic  arthritis, 
etc.  It  was  due  to  this  array  of  complications, 
many  of  which  might  and  some  of  which  did 
prove  fatal,  that  the  attention  of  the  profession 
was  focused  upon  it.  During  the  epidemic  14 
cases  came  under  my  care.  Of  these  six  were 
adults  and  eight  children,  six  males  and  eight 
females.  In  one  the  cervical  lymph  glands  sup- 
purated after  the  patient  had  been  ill  six  weeks. 
The  abscess  was  opened  and  drained,  and  the 
child  then  proceeded  to  make  an  uneventful  re- 
covery. In  two  there  was  suppurative  otitis  me- 
dia ;  in  two  arthritis ;  the  others  escaped  compli- 
cations. 

In  every  case  observed  by  me  there  was  a  his- 
tory of  a  sudden,  abrupt,  sharp  onset,  ushered  in 


with  chills,  rapidly  followed  by  severe  muscular 
pains  and  headache.  There  was  rapid  rise  in  tem- 
perature, in  one  case  reaching  104  4-50  Fahr. 
The  fever  frequently  exhibited  an  intermittant 
character.  A  temperature  which  had  been  102° 
Fahr.,  or  higher,  would  gradually  subside.  The 
patient  would  be  so  much  improved  that  visits 
would  be  discontinued.  In  a  few  days  another 
summons  would  be  received,  and  the  patient 
would  be  found  presenting  the  original  symptoms, 
only  aggravated.  In  every  instance  the  throat 
was  red,  swollen  and  congested.  In  some  patients 
the  tonsils  were  markedly  enlarged ;  in  others  not 
apparently  involved.  In  only  two  of  my  cases 
was  there  a  thin  grayish  membrane  on  the  tonsils. 
In  neither  did  it  entirely  cover  the  tonsils,  but 
occurred  in  patches.  Within  a  short  period  after 
the  onset  there  was  swelling  of  the  cervical  and 
submaxillary  lymph  glands,  which  enlargement 
occasionally  reached  huge  proportions.  The  pa- 
tients generally  complained  bitterly  of  pain  upon 
swallowing.  A  particularly  noticeable  feature 
was  the  excessive  prostration,  which  was  entirely 
out  of  proportion  to  the  severity  of  the  tonsillitis. 

Bacteriological  examinations  in  Baltimore,  as 
in  Chicago  and  Boston,  revealed  the  presence  of 
a  streptococcus  presenting  peculiar  characteris- 
tics. The  organisms  occurred  in  chains  or  pairs, 
and  were  surrounded  by  a  capsule,  which  led 
some  observers  to  believe  they  were  dealing  with 
the  pneumococcus.  The  germ  grew  abundantly 
on  blood  agar. 

A  noticeable  feature  of  the  Baltimore  epidemic 
was  the  localization  of  those  affected  to  a  well- 
defined  territory.  The  characteristics  of  these 
cases  were  entirely  dissimilar  to  symptoms  of 
tonsillitis  presenting  in  cases  elsewhere  in  the 
city.  Another  noteworthy  peculiarity  was  the 
limitation  of  the  victims  almost  entirely  to  users 
of  the  Hygeia  Dairy.  This  fact  led  observers  to 
believe  milk  was  in  some  way  connected  with  the 
malady.  When  one  takes  into  consideration  that 
4.6  per  cent,  of  the  cows  ( Capps  and  Miles,  Jour- 
nal of  the  American  Medical  Association)  supply- 
ing milk  to  the  dairy  in  Chicago  whose  consum- 
ers were  afflicted  were  affected  with  mastitis  from 
the  exudate  of  which  a  similar  organism  was  ob- 
tained in  pure  culture,  and  that  farmers  and  milk- 
ers in  contact  with  these  cows  were  afflicted  with 
the  same  form  of  sore  throat,  one  naturally  con- 
cludes   contaminated    milk    to    be    the    medium 


THE    HOSPITAL    BULLETIN 


109 


through  which  the  human  infection  occurred.  In 
confirmation  of  these  views  the  above  writers 
report  the  recovery  of  a  virulent  streptococcus 
from  the  milk  of  a  cow  and  the  throat  of  a  girl  on 
the  same  farm  who  was  ill  with  sore  throat  and 
arthritis. 

Considering  the  number  and  the  seriousness  of 
the  complications,  the  prognosis  should  be 
guarded. 

Prophylactic  treatment  consists  in  examining 
the  cows  from  which  the  milk  is  obtained.  If 
diseased  udders  are  found,  the  milk  should  be 
condemned.  During  such  an  epidemic  as  Balti- 
more passed  through  reliance  should  not  be  placed 
in  the  pasteurization  of  the  milk  by  the  dis- 
tributing dairies,  as  it  is  well  known  that  pas- 
teurization often  is  imperfect,  but  all  milk  con- 
sumed should  be  boiled. 

Every  line  of  local  throat  treatment  seemed  to 
be  equally  unavailing.  The  simple,  ordinary 
mouth  washes,  such  as  salt  water,  assisted  by  an 
occasional  mopping  off  of  the  infected  area  with 
a  5  per  cent,  carbolic-acid  solution  gave  as  good 
results  as  any.  The  antipyretics  in  my  hands 
were  rank  failures.  Build  up  the  resistance  pow- 
ers of  the  patient  with  good,  easily-digested,  nu- 
tritious food.  The  complications  should  be  treated 
as  such  diseases  would  be  treated  under  ordinary 
circumstances. 

The  only  case  upon  which  I  had  to  operate 
developed  a  suppurative  cervical  adenitis.  The 
patient,  a  boy  of  three  years,  had  been  ill  for  six 
weeks,  when  a  fluctuation  was  made  out  back  of 
of  the  ear.  At  the  time  he  was  running  a  tem- 
perature which  fluctuatetd  between  102  and 
104  4-50  Fahr.  He  was  operated  in  the  morning. 
By  evening  his  temperature  had  dropped  to  nor- 
mal and  remained  there.  Drainage  was  insti- 
tuted.    Recovery  was  uninterrupted. 


BOOK  REVIEWS 


Miss  Louise  Gephart,  LTniversity  Hospital 
Training  School  for  Nurses,  class  of  191 1,  is 
superintendent  of  the  Havre  de  Grace  Hospital 
of  Harford  County  (-Incorporated),  Havre  de 
Grace,  Md. 


Dr.  John  R.  Winslow,  class  of  1888.  is  spend- 
ing a  vacation  at  Edgeclift"  Hotel,  Gloucester, 
Mass. 


International  Clinics.  A  Quarterly  of  Illus- 
trated Clinical  Lectures  and  Especially  Pre- 
pared Original  Articles  on  Treatment,  Medi- 
cine, Surgery,  Neurology,  Pediatrics,  Obstet- 
rics, Gynecology,  Orthopedics,  Pathology, 
Dermatology,  Ophthalmology,  Otology, 
Rhinology,  Laryngology,  Hygiene  and  Other 
Topics  of  Interest  to  Students  and  Practition- 
ers. By  Leading  Members  of  the  Medical 
Profession  Throughout  the  World.  Edited 
by  Henry  W.  Cattell,  A.M.,  M.D.,  Philadel- 
phia, U.  S.  A.,  with  the  collaboration  of 
William  Osier,  M.D.,  Oxford;  A.  McPhe- 
dran,  M.D.,  Toronto:  Frank  Billings,  M.D., 
Chicago ;  Charles  H.  Mayo,  M.D.,  Roches- 
ter; Thomas  H.  Rotch,  M.D.,  Boston;  John 
G.  Clark,  M.D.,  Philadelphia;  James  J. 
Walsh,  M.D.,  New  York :  J.  W.  Ballantyne, 
M.D.,  Edinburgh ;  John  Harrold,  M.D.,  Lon- 
don ;  Richard  Kretz,  M.D.,  Vienna.  With 
regular  correspondents  in  Montreal,  London, 
Paris,  Berlin,  Vienna,  Leipsic,  Brussels  and 
Carlsbad.  Volume  XI,  twenty-second  series. 
1912.  Philadelphia  and  London:  J.  B.  Lip- 
pincott  Company.    Cloth  ;  $2  net. 

The  present  volume  is  teeming  with  questions 
vital  to  the  medical  profession,  such  as  Pellagra, 
a  Lecture  on  the  Present  Status  of  Epidemic 
Poliomyelitis,  the  Dangers  of  the  Underfeeding 
of  Infants,  Direct  Method  of  Examination  of  the 
Larynx,  Trachea,  Bronchi,  Esophagus  and  Stom- 
ach, and  Cerumen  in  the  Ears. 

Perhaps  the  most  important  of  all  the  contribu- 
tions is  that  by  Simon  Flexner  on  the  present 
status  of  epidemic  poliomyelitis.  At  any  rate, 
owing  to  the  enormous  increase  and  general  dis- 
tribution and  present  excessive  presence  of  polio- 
myelitis, it  is  the  most  timely.  Dr.  Flexner  rightly 
states  that  the  medical  profession  of  this  country 
should  awaken  to  the  fact  that  we  have  amongst 
us  a  severe  epidemic  of  this  disease.  He  is  also 
of  the  opinion  there  is  no  telling  how  long  it  will 
remain :  therefore,  the  sooner  the  profession  and 
the  public  come  to  a  realization  of  this,  and  the 
fact  that  the  only  method  we  have  at  present  for 
its  control  is  isolation,  the  better  for  all.  Since 
the  summer  of  1907  epidemic  poliomyelitis  has 
extended  from  the  Atlantic  seaboard,  where  it 
first  appeared,  throughout  the  length  and  breadth 


I  IO 


THE    HOSPITAL    BULLETIN 


of  this  country.  It  was  not  until  1909  that 
experimenters  were  able  to  transfer  the  malady 
to  animals — in  this  instance  the  monkey — 
and  is  done  by  directly  injecting  the  cerebro- 
spinal fluid  from  an  affected  individual  di- 
rectly into  the  brain  of  a  monkey.  This  experi- 
ment taught  us  that  the  incubation  period  was 
from  three  to  thirty  days,  averaging  about  eight. 
According  to  the  author,  it  has  been  definitely 
proven  that  the  cause  of  the  disease  leaves  the 
body  through  the  pharyngeal  and  nasal  mucosa, 
and  that  the  disease  is  contagious.  Admitting 
these  conceptions  of  the  disease,  he  states,  its  pre- 
vention lies  in  the  employment  of  the  same  meth- 
ods used  in  diphtheria,  scarlet  fever,  etc.  The 
sick  should  be  separated  from  the  well.  The  dis- 
charges which  contain  the  virus  must  be  de- 
stroyed, and  a  sufficient  time  must  be  allowed  for 
isolation  to  make  it  at  least  highly  probable  that 
the  infectious  agent  has  disappeared  from  the 
nasal  and  buccal  secretions.  Work  done  on  a  pre- 
ventive serum  leaves  the  writer  full  of  hope  of 
finding  a  therapeutic  control  for  the  disease.  This 
article  alone  is  well  worth  the  price  of  the  vol- 
ume. The  article  on  pellagra  is  also  of  more  than 
ordinary  merit  and  can  be  read  with  both  pleasure 
and  instruction. 


The  Pituitary  Body  and  Its  Disorders.    Clini- 
cal   States    Produced   by    Disorders   of   the 
Hypophysis  Cerebri.     By  Harvey  Cushing, 
M.D.,   Associate  Professor  of   Surgery  the 
Johns    Hopkins    University;    Professor    of 
Surgery    (Elect)    Harvard   University.     An 
amplication  of  the  Harvey  lecture   for  De- 
cember,  kjio.     319  illustrations.     Philadel- 
phia  and   London:   J.    P>.    Lippincott   Com- 
pany. Cloth.  $4  net.     1912. 
Recent  investigations  of  the  glands  of  internal 
secretion  have  thrown  much  light  on  many  mala- 
dies  whose   etiology   was   heretofore   hidden    in 
darkness.     Surgery  has  done  much  in  clarifying 
the  atmosphere.     With   our  present  knowledge, 
however,   the   explanation    of   many   phenomen  1 
remains  in  darkness.  •  The  work  done  on  the  thy- 
roid blazed  the  way  for  the  solving  of  the  part 
the  other  ductless  glands  played   in  the  human 
economy.     One  of  the  last  of  the  ductless  rests 
to  be  brought  into  daylight  is  the  pituitary  body. 
Its  existence  has  been  known   for  many  years, 
but    its   use  has   remained  hidden   until   a  com- 
paratively recent  date.     Much  of  the  credit  for 


the  solving  of  its  status  is  due  Harvey  Cushing 
of  the  Johns  Hopkins  University  and  his  cowork- 
ers in  that  institution.  During  the  past  few  years 
Cushing  has  done  monumental  work  in  experi- 
mental and  clinical  pituitary  surgery.  He  has 
proven  some  of  the  theories  brought  out  by 
brother  workers,  and  disproved  many  fantastic 
ideas  of  the  past.  Perhaps  the  most  important 
feature  of  Cushing*s  observations  on  this  gland 
are  the  variations  of  the  symptoms  according  to 
whether  the  gland  is  in  a  state  of  over  or  minus 
activity,  and  the  perfection  of  a  surgical  method 
of  attack.  Undoubtedly  Cushing's  investiga- 
tions upon  this  organ  will  stand  as  a  masterpiece 
of  its  kind,  especially  as  a  basis  for  future  experi- 
menters to  follow.  Though  much  is  known  con- 
cerning the  activities  of  the  ductless  glands, 
many  problems  remain  unsolved.  Those  inter- 
ested in  what  has  been  and  what  is  being  done  in 
pituitary  surgery  are  fortunate  in  being  able  to 
obtain  under  one  cover  and  at  a  moderate  price 
the  labors  of  Cushing  and  his  co-operators  on  the 
hypophysis  cerebri.  The  book  is  an  amplifica- 
tion of  the  Harvey  lecture,  delivered  in  Decem- 
ber, 1910,  before  the  New  York  Academy  ol 
Medicine.  It  contains  not  only  the  work  done 
up  to  the  date  of  the  delivery  of  the  lecture,  but 
that  done  since  then;  a  historical  review  of  the 
subject,  anatomy,  physiology,  morphology,  path- 
ological anatomy,  organo-therapy,  chemistry  of 
the  gland,  clincal  manifestations  of  disordered 
function,  symptomatology  and  treatment.  Every- 
body— internist,  surgeon,  pathologist,  chemist, 
radiologist,  neurologist,  oculist,  gynecologist,  etc. 
— should  be  interested  in  this  contribution  to 
medical  literature,  as  the  symptoms  are  refer- 
able to  practically  every  organ  of  the  body.  For 
instance,  in  pituitary  insufficiency  there  is  in- 
terference with  vision,  amenorrhea,  non-develop- 
ment of  the  genital  organs,  enlargement  of  the 
sella  tursica,  high  carbohydrate  tolerance,  etc. 
With  these  features  the  volume  should  appeal  es- 
pecially to  those  who  desire  to  be  abreast  of  the 
times,  as  there  is  not  the  least  doubt  in  the  mind 
of  the  writer  that  pituitary  faults  are  at  present 
overlooked  as  much  as  thyroid  were  in  the  past. 


Dr.  William  Tarun,  class  of  1900,  has  been 
forced  to  give  up  his  practice  for  a  while  because 
of  illness.  We  wish  him  a  speedy  restoration 
to  his  usual  good  health. 


THE    HOSPITAL    BULLETIN 


1 1 


THE  HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

PUBLISHED  BY 

THE   HOSPITAL  BULLETIN  COMPANY 

608  Professional  Building 

Baltimore,  Jin. 


Subscription  price,     .     .     .     $1.00  per  annum  in  advance 

Reprints   furnished   at   cost.     Advertising   rates 
submitted  upon  request 


Nathan  Wlxsi.ow.  M.D.,  Editor 


Baltimore,  August  15,  1912. 


DR.  ERNEST  ZUEBLIX. 


There  have  been  many  inquiries  directed  to  us 
concerning  Dr.  Ernest  Zueblin.  The  editor  has 
frequently  been  asked  who  is  he,  where  is  he 
from  and  what  lias  he  done?  We  therefore  take 
this  occasion  to  publish  the  data  we  have  in  hand. 

Dr.  Zueblin,  Professor  (elect)  of  Medicine  in 
the  University  of  Maryland,  after  five  years  of 
stud)-  at  Heidelberg.  Zurich  and  Lausanne,  was 
awarded  the  degree  of  M.D.  from  the  last  insti- 
tution in  1903.  In  1903  and  11)04  he  did  gradu- 
ate work  at  Munich  under  Professors  Midler  and 
Bauer.;  in  [904-1905,  he  was  assistant  to 
Geheimrat  Professor  Leube  at  University 
of  Wurtzburg;  1905-1906,  assistant  to  Pro- 
fessor C.  Roux  at  University  of  Lausanne: 
[906-1907,  first  assistant  to  Geheimrat  Professor 
W.  Fleiner  at  Heidelberg;  [907-1909,  associate 
physician  at  the  sanitarium  of  Dr.  A.  Widmer  at 
Valmont.  Territet,  post-graduate  work  at  Munich 
and  lierlin  under  Professors  Ewald,  Rosenheim 
and  Strauss:  [909-1911,  assistant  to  Professor 
Max  Einhorn  (  Xew  York  ),  pathologist  to  Tuber- 
culosis League  Hospital,  Pittsburgh;  191 1.  at- 
tending physician  to  Western  Pennsylvania  Hos- 
pital;  ii)ii-ii)i2.  attending  physician  Allegheny 
General  Hospital,  Pittsburgh.  Dr.  Zueblin  since 
graduating  from  University  of  Lausanne  has  been 
engaged  continuously  in  institutional  work  in  the 
universities  of  Europe  and  the  United  States.  Dr. 
Einhorn  of  Xew  York  gives  him  the  highest  rec- 


ommendations, ana  those  who  have  met  him  at 
the  University  of  Maryland  have  been  very  fav- 
orably impressed  with  him.  As  far  as  can  be  de- 
termined now,  he  is  the  man  for  the  place, 
and  his  election  has  been  well  received  by  his 
coworkers  to  be  in  the  department  of  medicine. 
Dr.  Zueblin  has  a  very  attractive  personality, 
and  we  feel  will  soon  win  the  respect,  friendship 
and  love  of  his  fellow-workers,  students  and 
alumni.  It  is  needless  to  slate  after  such  an  ex- 
perience in  post-gradute  work  that  he  is  eminently 
fitted  for  the  position.  The  Bulletin  extends, 
in  the  name  of  the  Faculty  of  Physic,  Adjunct 
Faculty,  alumni  and  students  a  most  cordial  wel- 
come to  Professor  Zueblin  as  a  member  of  our 
Faculty,  and  bespeaks  for  him  the  loyal  support 
of  the  members  of  his  department. 


AX  EXPLANATION. 


In  the  July  issue  of  The  Bulletin  the  edi- 
torial, "Who  Shall  It  lie."  was  wrongly  inter- 
preted by  many.  In  justice  to  the  medical  mem- 
bers on  the  Board  of  Regents,  the  editor  feels' 
constrained  to  explain  to  the  readers  of  Tut: 
Bulletin  that  they  are  on  the  right  side.  Each 
and  every  one  of  them  stands  for  progress.  They 
have  the  best  interests  of  the  Medical  School  and 
University  at  heart,  and  will  not  stop  at  anything 
within  their  power  to  advance  the  University. 
Those  outside  the  Board  of  Regents  are  loudly 
calling  for  trustees  not  connected  with  the  teach- 
ing bodies.  The  editor  desires  to  impress  upon 
the  alumni  and  those  interested  in  the  uplift  of  the 
University  of  Maryland  that  the  members  of  the 
Faculty  of  Physic  (  and  this  includes  the  Faculty 
of  Dentistry  and  the  Faculty  of  Pharmacy)  have 
and  are  endeavoring  to  bring  this  happy  result 
about.  They  are  fully  alive  to  the  needs  of  the 
institution,  as  much  so  as  any  of  us,  but  how  to 
accomplish  the  change  is  what  is  bothering  them. 
The  law  faculty  is  the  stumbling  block. 

These  men  say  they  are  satisfied  with  condi- 
tions. Their  school,  unhampered  by  such  expen- 
sive requirements  as  laboratories,  clinics,  etc.,  is 
flourishing.  Their  expenses  are  naturally  much 
smaller  than  those  of  the  other  schools.  They  do 
not  outwardly  state,  however,  that  they  are  ap- 
parently interested  only  in  the  "come  back"  they 
get  from  the  old  cow.  Sooner  or  later,  as  in  the 
case  of  the  School  of  Medicine,  the  old  cow  will 


112 


THE    HOSPITAL    BULLETIN 


go  dry.  The  Law  School  is  not  so  strong  that  it 
can  withstand  the  stress  of  competition  from  a 
law  school  of  high  standard  which  is  bound, 
sooner  or  later,  to  be  organized  in  our  midst.  At 
that  time  the  University  of  Maryland  Law  School 
will  find  itself  in  an  identical  plight  as  that  which 
the  Medical  School  faces  today,  but  it  will  then  be 
too  late  to  change  the  organization  of  the  schools. 

By  "reactionaries"  was  meant  the  members  of 
the  Law  Faculty,  and  from  their  present  actions 
it  seems  they  are  more  interested  in  their  pocket- 
books  than  the  success  of  the  University  of  Mary- 
land. 

All  hail  to  those  members  of  the  Faculty  of 
Physic,  who,  in  order  to  supply  six  full-time  men, 
were  willing  to  forego  any  remuneration  for  their 
own  services.  The  editor  could  not  and  would 
not  let  the  impression  go  forth  that  they  were  or 
are  negligent  to  their  trust. 


VACATION   TIMES. 


Every  schoolboy  rejoices  when  the  school  bell 
rings  for  the  last  time  and  he  is  released  from  the 
routine  of  school  life  "and  is  free  to  follow  the 
bent  of  his  own  erratic  inclination.  To  those 
who  are  older  and  whose  work  is  of  a  more  seri- 
ous character  vacation  time  is  also  none  the  less 
pleasant.  It  is  an  old  and  trite  saying  that  "All 
work  and  no  play  makes  Jack  a  dull  boy."  Not 
only  do  school  boys  and  girls  require  a  time  of 
rest  and  recuperation,  but  it  is  very  essential  that 
everyone,  and  especially  those  who  are  bearing 
heavy  responsibilities,  should  have  a  time  in 
which  to  refresh  their  minds  and  bodies  and  to 
drink  in  new  truths  at  the  font  of  nature.  Phy- 
sicians become  so  engrossed  in  their  duties  that 
many  of  them  forget  to  take  the  necessary  time 
in  which  to  secure  a  change  of  scene  and  sur- 
roundings. It  is,  however,  becoming  more  and 
more  recognized  that  a  physician  becomes  a  more 
useful  member  of  the  community  when  he  takes 
a  reasonable  time  for  his  own  recreation  and 
instruction. 

University  work  ceased  on  June  i,  and  most 
of  the  students  have  scattered  far  and  wide.  The 
closing  of  the  accounts  and  records  of  the  past 
session  and  the  preparations  for  the  next  session 
kept  the  various  members  of  the  Faculty  in  the 
city  until  the  middle  of  July,  but  several  have 
now   left   on   more   or   less   prolonged    leave   of 


absence.  Professor  Hemmeter  is  spending  the 
summer  in  Maine,  as  the  cooler  weather  of  the 
North  is  beneficial  to  his  health.  Professor 
Neale,  as  usual,  spends  the  summer  at  Ocean 
City,  Md.  Professor  Gilchrist  has  gone  to  Eng- 
land. Professor  Ashby  has  taken  a  house  at 
Roland  Park  and  will  spend  the  summer  at  that 
delightful  suburb,  while  Professor  Winslow  is 
again  indulging  his  fondness  for  travel  by  mak- 
ing a  journey  to  Cuba,  Panama  and  Central 
America. 

In  consequence  of  the  absence  of  Professor 
Winslow  we  cannot  present  a  long  list  of  new 
subscriptions  to  the  pathological  endowment 
fund,  but  are  pleased  to  be  able  to  announce  sev- 
eral very  acceptable  contributions,  which,  if  not 
as  large  as  the  donors  would  like  them  to  be,  at 
least  are  evidences  of  their  good-will  and  con- 
structive sympathy.  We  are  engaged  in  an  enor- 
mous struggle  to  put  and  keep  our  school  on  a 
satisfactory  basis.  All  teachers  of  practical 
branches  must  serve  without  salary  hereafter. 
We  can  do  no  more.  If  you  love  your  Alma 
Mater,  help  us  to  sustain  her. 


CONTRIBUTION     BY    CLASSES. 


848. 
864. 

868. 

871. 

872. 

873- 
874. 

875- 

876. 
877. 
880. 
881. 
882. 

883. 

885. 

886. 


889. 
890. 
892. 

893- 
894. 

895- 
806. 
897. 
898. 
899. 


$50  00 
20  CO 
10  00 
35  oo 
70  00 

430  00 
5  00 
5  00 

115  00 
10  00 

5  00 
250  00 
310  00 

35  00 
235  00 
100  00 

50  00 
100  00 
175  00 
150  00 

40  00 
135  00 
155  00 

52  00 

80  00 
105  00 

50  00 


THE    HOSPITAL    BULLETIN 


"3 


190 1 240  00 

1901 240  oo 

1902 305  00 

1903 3'5  00 

1904 145  00 

1905 210  00 

n>o() 165  OO 

1907 1 10  00 

T908 20  00 

1909 5  00 

1910 50  00 

191 1  Terra  Mariae 3  5° 

19 1 2  Club  Latino  Americano 25  00 


Total  subscriptions  to  August  1,  igi2.$io,i36  50 

NEW    SUBSCRIPTIONS    IN    JULY. 

Geo.  H.  Cairnes,   1864 $20  00 

S.  Griffith  Davis,  1893 25  00 

Geo.  H.  Stewart,  189*; 25  00 

Henry  Lyon  Sinskey,   1908 10  00 

Total $80  00 


ABSTRACT 


Dr.  Watson  Smith  Rankin,  class  of  1901,  sec- 
retary to  the  State  Board  of  Health  of  North 
Carolina,  presents  an  argument  (  Old  Dominion 
Journal,  July,  1912)  setting  forth  the  value  of 
vital  statistics  in  the  work  of  safeguarding  the 
health  of  a  community,  in  which  he  says,  in  part : 

The  happy  girl  of  sixteen,  in  her  exuberant 
health,  accepts  her  greatest  blessings  as  a  natural 
inheritance,  as  natural  as  the  sunshine,  and  gives 
it  as  little  thought.  Her  attitude  to  health  is  one 
of  indifference.  Time  passes  and  girlhood  fades 
into  womanhood ;  death  knocks  at  her  door ;  her 
baby  answers  the  summons ;  blinded  with  the  bit- 
ter tears  of  sorrow,  she  falls  on  Providence.  Her 
attitude  to  health  is  one  of  fatalism.  Time  moves 
on,  and  observation,  sharpened  with  the  friction 
of  the  years,  discerns  relationship  between  pre- 
existing and  subsequent  disease,  between  environ- 
ment and  disease,  and  slowly  there  is  evolved  a 
consciousness  of  control  over  disease-producing 
factors.  Health  fatalism  recedes  as  the  light  of 
the  most  powerful  fact  of  the  nineteenth  century 
— the  preventability  of  diseases — enters  her  mind  ; 
the  spirit  of  the  dead  baby  calls  her  attention  to 
the  terrible  meaning  of  the  needless  death,  awak- 
ens her  conscience  to  its  part  in  the  great  conflict 


of  life  and  death,  and  a  raw  recruit  enters  the 
army  of  health  workers.  Her  eagerness  to  do 
something  will  not  permit  of  the  development  of 
nature  plans.  The  desire  to  serve  overbalance-* 
ability  to  serve:  public  health  is  more  philosophy 
than  science.  Her  attitude  to  health  is  one  of 
unco-ordinated  enthusiasm,  characterized  by  spas- 
modic and  sporadic  efforts  to  prevent  disease. 
Finally,  with  the  novelty  of  the  new  idea  worn 
off,  with  the  sedative  effect  of  the  fatigue  of 
sporadic  and  exaggerated  effort,  cold  reason  re- 
sumes her  throne,  and  puts  the  blunt  question : 
Where  are  the  fruits  of  your  labor?  Exactly 
what  do  you  seek  ?  What  evidence  is  there  to  in- 
dicate the  value  or  futility  of  your  effort  ?  The 
health  enthusiast  begins  to  think,  to  seek  some 
fixed  point  from  which  progress  may  be  measured, 
and  vital  statistics  as  an  absolute  necessity  in 
health  work  is  recognized.  With  that  discovery 
philosophy  gives  way  to  science,  and  exuberant 
enthusiasm  to  steady,  rational  effort.  The  atti- 
tude to  health  is  rational,  scientific. 

These  four  mental  attitudes  to  health — the  in- 
different, the  fatalistic,  the  enthusiastic  and  the 
rational  or  scientific — are  found  in  varying  pro- 
portions in  the  public  opinion  of  different  places, 
and  so  in  accordance  with  the  dominant  mental 
attitude  is  the  attitude  of  the  Government  to 
health  work,  indifferent,  fatalistic,  enthusiastic  or 
rational. 

The  indifferent  and  fatalistic  types  of  mind  are 
passing  rapidly  into  extinction.    God  speed  them  ! 

The  enthusiastic  type  of  mind  is  still  rare 
enough  to  be  appreciated  when  found.  This  type 
makes  a  good  supporter,  but  a  bad  counselor  for 
the  health  officer.  People  of  this  type  are  vision- 
ary ;  they  have  schemes  for  cleaning  up  the  town 
or  county  in  less  time  than  it  takes  to  bathe  a 
baby ;  they  regard  a  board  of  aldermen  or  com- 
missioners as  an  absolute  and  not  as  a  representa- 
tive power ;  they  waste  valuable  energy  in  vain 
endeavor  to  scale  the  heights,  rather  than  take 
the  more  circuitous  path  of  popular  education 
that  will  surely  in  the  end  bring  them  in  sight  of 
the  promised  land ;  they  appraise  a  health  officer 
by  the  amount  of  appropriation  that  he  is  instru- 
mental in  securing,  by  the  number  of  speeches  he 
makes,  and  by  the  amount  of  literature  he  scat- 
ters, some  by  the  wayside,  some  upon  the  stony 
ground,  and,  thank  God,  some  upon  good  soil. 

The  scientific  attitude  to  public  health  recog- 
nizes society  in  its  entirety  and  not  as  unrelated 


114 


THE    HOSPITAL    BULLETIN 


fragments,  not  as  so  many  thousand  or  million 
individuals,  but  as  Herbert  Spencer  saw  it,  as  a 
unity,  a  "social  organism."  To  the  scientific  mind 
the  individual  is  to  the  social  organism  what  the 
cell  is  to  the  cellular  organism ;  the  industrial  or 
social  class  to  the  social  organism,  what  the  organs 
or  groups  of  cells  of  like  function  are  to  the  cellu- 
lar organism.  In  the  one  as  in  the  other,  units 
and  classes  or  organs  are  mutually  dependent  and 
bound  into  a  co-ordinated  potentiality. 

This  social  organism  may  become  diseased  just 
as  the  cellular  organism,  and  like  it  exhibit  dis- 
ease phenomena  or  symptoms.  These  disease 
phenomena  or  symptoms  are  as  essential  in  the 
diagnosis  and  treatment  of  diseases  of  the  social 
organism  as  they  are  necessary  to  the  proper 
diagnosis  and  treatment  of  diseases  of  the  cellular 
organism. 

As  a  symptom  in  the  cellular  organism  is  the 
expression  not  of  one,  but  of  many  cells,  so 
symptoms  of  disease  of  the  social  organism  are 
civic  rather  than  individual  expressions.  These 
symptoms  are  in  terms  of  per  thousand  or  per 
hundred  thousand  population. — in  short,  in  the 
very  nature  of  the  case  they  must  be  statistical. 
Inasmuch  as  they  relate  to  conditions  of  life,  they 
are  properly  called  vital  statistics.     *     *     :;: 

The  doctor  who  recognizes  only  the  common 
characteristics  of  a  disease  and  overlooks  the 
peculiarities  contributed  by  certain  individual  fac- 
tors, and  who  treats  disease  by  rule  of  thumb 
methods,  and  ignores  individual  modifying  fac- 
tors, is  not  to  be  classed  as  a  first-rate  scientific 
physician.  Likewise,  the  sanitarian  who  gives 
the  general  tonic  treatment  of  sanitary  education 
to  every  sick  town  or  county,  and  fails  to  meet 
the  special  indications  in  each  particular  town  or 
county,  falls  far  short  of  his  opportunities  as  a 
health  officer. 

I  repeat,  for  emphasis,  there  is  a  symptomatol- 
ogy of  disease  of  the  social  organism  :  it  is  as  nec- 
essary in  the  intelligent  treatment  of  diseases  of 
the  social  organism  as  is  a  knowledge  of  the  mean- 
ing of  symptoms  in  the  treatment  of  diseases  of 
the  cellular  organism.  My  endeavor  in  this  paper, 
so  far,  has  been  to  call  your  attention  to  just 
enough  of  this  symptomatology  to  show  its  ex- 
istence and  suggest  its  inestimable  value.  It  is 
admitted  that  the  symptomatology  of  diseases  of 
the  body  politic  is  not  a  perfect  science  yet.  As 
the  symptomatology  of  personal  diseases  was 
relatively  simple  and  undeveloped  fifty  years  ago 


as  compared  with  the  present,  so  will  develop  the 
symptomatology  of  public  disease  in  the  near 
future.  But  even  now,  the  fact  should  be  recog- 
nized that  a  health  administration  that  pursues  its 
course  without  a  close  study  of  symptoms,  of  vital 
statistics,  is  unscientific,  pursuing  its  way  with- 
out compass  or  chart  on  the  ocean  of  life  blindly 
working  in  the  dark,  and  may  find  some  day, 
when  the  light  of  truth  breaks  through  the  clouds 
of  ignorance,  that  all  its  building  has  been  on  the 
shifting  sand  of  opinion,  and  not  upon  the  rock 
of  eternal  fact.  My  first  point  then  is,  that  scien- 
tific health  work  must  rest  on  a  basis  of  vital  sta- 
tistics, and  that  such  statistics  are  in  their  mean- 
ing analogous  to  the  symptoms  of  personal 
disease. 

Another  value  of  vital  statistics,  second  only  to 
their  value  in  the  intelligent  treatment  of  disease 
of  the  social  organism,  is  their  influence  in  re- 
moving public  health  work  from  politics.  Once 
the  people  have  grasped  firmly  the  fact  that  a 
health  officer  is  one  who  reduces  death  rates  or 
increases  average  longevity,  the  health  work  of 
this  country  will  be  established  upon  a  basis  of 
genuine  merit  and  not  upon  popular  whim  or 
political  favor.  A  government  that  re-elects, 
elects  or  maintains  any  person  who  has  not  or 
does  not  show  the  effects  of  his  work  in  a  definite 
saving  of  human  life  and  health,  will  never  be 
tolerated.  The  health  officer  who  can  "deliver 
the  goods,"  pardon  the  slang  for  its  expressive- 
ness, will  be  in  demand,  can  command  his  own 
salary,  and  even  better  than  that,  deserve  it. 
When  that  good  time  comes  the  best  minds  in 
medicine  will  he  shifted  from  curative  to  pre- 
ventive medicine,  the  newest  specialty  will  lie  the 
greatest  specialty,  the  specialty  that  pays  best  and 
affords  the  greatest  opportunity  for  glorious 
achievement — public  health  will  have  come  into 
its  own. 

In  conclusion,  the  only  method  of  health  work- 
that  will  ever  be  effective  must  rest  upon  a  system 
of  facts  furnished  by  vital  statistics. 

The  ideal  in  the  public  health  work  of  this 
State  for  which  we  incessantly  long  is  a  State- 
wide enforcible  vital  statistics  law,  that,  with  the 
powerful  pressure  of  public  opinion  and  that 
primal  instinct,  self-preservation,  will  make  it  im- 
possible for  the  State  itself  to  ever  become 
afflicted,  for  any  length  of  time,  with  a  public 
health  administration  that  cannot  justify  its  ex- 
istence in  a  decrease  in  the  State's  death  rate — 


THE    HOSPITAL    BULLETIN 


£15 


the  absolute  test  of  efficiency  in  health  administra- 
tion ;  that  will  make  every  one  of  the  one  hundred 
county  health  officers  of  this  State  competitors  in 
a  great  life-savin.;  contest  with  the  other  ninety- 
nine;  that  will  forever  divorce  public  health  work 
from  politics;  that  will  give  the  health  officer  the 
exact  recognition,  rating;  and  compensation  that 
he  merits  as  indicated  by  the  death  rate  of  his 
constituency  ;  that  will  make  public  health  work 
as  attractive  to  strong  men  as  it  is  needed  by  a 
grievously  and  needlessly  sick  social  organism; 
that  in  the  course  of  a  few  years  will  change  the 
death  rate  in  North  Carolina  from  18.4  per  thou- 
sand to  12  or  13  per  thousand,  which  means  the 
saving  of  ten  thousand  lives  a  year  with  the  con- 
comitant amount  of  sickness,  suffering  and 
anxiety  that  goes  with  so  great  a  loss  of  life ;  an 
ideal  that  will  at  least  suggest  that  ecstatic  vision 
wherein  the  old  ideals  and  old  order  of  things 
have  passed  away,  and,  in  their  place,  a  new 
heaven  and  a  new  earth  adorned  as  a  bride  for 
her  husband. 

I  Editor's  Note. — Dr.  Rankin's  comment  on  a 
health  officer  who  can  "deliver  the  goods"  is  per- 
haps borne  out  in  Boston's  recent  appeal  to  the 
physicians  of  America  to  enter  the  lists  for  chair- 
manship of  her  Board  of  Health.  Everywhere  a 
call  is  being  made  for  competent  men,  and  places 
await  them.l 


ITEMS 


Dr.  \\illiam  J.  Todd  of  Mount  Washington 

has  the  following  to  say  of  Dr.  Horatio  Gates 
Jameson.  Jr.,  and  thus  adds  to  our  history  of  the 
descendants  of  Dr.  Jameson  of  the  class  of  1913: 
1  loratio  ( iates  Jameson,  youngest  son  of 
Horatio  (iates  Jameson  and  Catherine  (  She  veil ) 
Jameson,  was  born  in  Baltimore,  <  )ctober  1,  1815  ; 
graduated  at  the  Ohio  Medical  College  in  1836; 
commenced  the  practice  of  medicine  in' Cincinnati, 
then  to  lialtimore  city,  later  at  Church  Hill,  "on 
the  high  road  running  between  Elkton  and 
Easton,"  in  Queen  Anne's  county,  .Maryland,  in 
1841.  Dr.  Jameson  continued  to  practice  medi- 
cine on  the  Eastern  Shore  until  about  1843,  when 
he  removed  to  Baltimore  city,  thence  to  Baltimore 
county,  locating  at  Brooklandville,  on  the  Rider 
estate ;  then  to  the  village  of  Rockland,  on  the 
Falls  road  turnpike,  living  in  an  old  stone  house, 
lately  remodeled  and  occupied  by  Mr.  Bryan,  the 
owner   of    Rockland    Flour    Mills.      August    23, 


1856,  Dr.  Jameson  bought  a  small  tract  of  land 
on  Hare  llill  from  Mr.  Johnzey  Hook,  known 
then  as  "Hector's  Hop  Yard,"  upon  which  he 
built  the  large  and  comfortable  house  lately  owned 
by  Mrs.  Jane  Wright.  Dr.  Jameson  died  in  this 
house  of  tuberculosis  in  August,  1865. 

His  wife  was  Sarah  McCulloh  I'ortcr  (married 
in  1841  ),  daughter  of  Parnell  and  William  Porter, 
a  merchant  of  lialtimore  city.  She  survived  him 
only  a  few  weeks,  dying  at  the  house  of  her  sister, 
Mrs.  William  Hanna.  in  Baltimore  city.  There 
was  only  one  child  by  this  union,  a  daughter, 
Kate,  who  died  about  the  age  of  six  years. 

Dr.  Jameson  was  a  man  of  versatile  accom- 
plishments. He  was  musical,  playing  skillfully 
upon  the  flute,  his  favorite  instrument.  He  was 
also  an  artist  of  some  note. 

He  was  tall,  slender  and  inclined  to  stoop 
shoulders ;  had  a  deep,  musical  voice ;  very  amia- 
ble and  mild  in  manner.  As  might  be  expected  of 
one  who  was  a  painter  and  musician,  he  was  exact 
as  to  the  carrying  out  of  the  details  in  the  treat- 
ment and  nursing  of  his  patients. 

A  lady  who  recalls  Dr.  Jameson  states:  "He 
was  the  first  physician  to  use  a  buggy  in  this  sec- 
tion ;  he  had  a  large  practice,  requiring  long 
drives." 

Indirectly,  the  death  of  Dr.  Jameson  was  due 
to  a  severe  wetting  he  received  while  on  his  way 
to  see  his  patients.  He  was  crossing  Jones  Falls 
on  horseback,  when  a  washerwoman  flaunted  a 
piece  of  the  wash  in  the  face  of  the  doctor's  horse, 
which  became  frightened  and  unmanageable, 
throwing  the  doctor  on  his  back  into  the  water. 
Not  heeding  the  fall  and  the  wetting,  he  continued 
on  his  way,  seeing  several  patients,  returning  ho  ne 
late,  with  his  clothing  wei  and  he  chilled.  From 
this  accident  and  exposure  he  contracted  a  severe 
cold,  from  which  he  never  recovered,  and  which, 
no  doubt,  was  the  primary  cause  of  his  death. 

The  late  Thomas  Wright  of  Rockland  remem- 
bered this  man,  and  called  upon  him  for  medical 
advice.  Dr.  Jameson  saw  his  patients  profession- 
ally almost  to  the  day  of  his  death. 

After  the  death  of  Mrs.  Jameson  their  home- 
stead was  purchased  by  Dr.  Steele,  who  remained 
a  short  time,  and  then  sold  to  .Admiral  Porter, 
whose  mother,  with  another  son,  spent  the  last 
years  of  her  life  there. 

Dr.  Jameson  was  a  descendant  of  a  David 
Jameson,  a  graduate  of  the  renowned  University 
of    Edinburgh,    who    emigrated    to    this    country 


n6 


THE    HOSPITAL    BULLETIN 


about  1740,  landing  in  Charlestown,  S.  C.  Leav- 
ing there,  he  settled  in  Pennsylvania.  His  de- 
scendants of  the  fourth  and  fifth  generation  re- 
sided in  Shippensburg  and  at  York.  In  1796  he 
was  living  and  practicing  his  profession  in  Ship- 
pensburg, Pa.,  where  it  is  believed  he  died.  David 
Jameson  was  lieutenant-colonel  of  the  Provincial 
forces  and  colonel  of  the  Revolutionary  forces  of 
Pennsylvania. 

His  commissions  as  captain,  brigade-major  and 
lieutenant-colonel,  also  as  colonel  of  militia  of 
Pennsylvania  during  the  Revolutionary  War,  are 
in  the  hands  of  his  maternal  great-grandson,  who 
is  Horatio  Gates  Gibson,  Colonel  Third  Regiment 
Artillery  and  Brevet  Brigadier-General  of  United 
States  Army,  Washington  Barracks,  Washington, 
D.  C.  Of  this  man's  children,  two  sons,  Horatio 
Gates  and  Thomas,  followed  the  profession  of 
their  father.    Thomas  settled  in  York.  Pa. 


The  University  of  Maryland  record  at  the  re- 
cent State  Board  examinations  is  as  follows : 


3      >> 


>-. 


Dr.  Edward  Sanborn  Smith,  class  of  1900,  of 
-Macon,  Mo.,  is  spending  a  unique  vacation  cruis- 
ing in  the  Mississippi  and  its  branches.  He  is 
accompanied  by  his  friend,  Harry  M.  Rubey. 
president  of  the  Rubey  Trust  Co.  of  Macon.  The 
two  left  St.  Paul,  Sunday,  July  15,  to  cruise  down 
the  Mississippi  to  Grafton,  then  up  the  Illinois 
River,  through  the  Illinois-Michigan  Canal  and 
Chicago  River,  across  Lakes  Michigan  and  Huron 
to  Georgian  Bay,  Canada,  and  back  to  St.  Paul, 
in  all  some  three  thousand  miles.  The  trip  is  be- 
ing made  in  the  50-foot  launch  Elizabeth.  Dr. 
Smith  will  have  charge  of  the  engine-room.  Mr. 
Rubey  will  be  the  skipper.  The  bill  of  fare  for 
the  voyage  will  be  "jest  plain  country  eatings" — 
fish,  roast  beef  and  corn,  corn  dodger,  molasses, 
potatoes  and  strong  coffee.  Dr.  Smith  says : 
"The  purpose  of  our  voyage  is  to  study  naviga- 
tion, to  hunt  up  picturesque  shore  lines  and  to 
take  good  pictures  of  the  natives  and  the  scenery. 
If  our  adventures  justify  it,  I'll  order  the  cook  to 
write  a  book  about  them  between  meals.  Should 
we  be  boarded  by  pirates,  we  have  a  phonograph 
which  sings  Casey  Jones  and  other  deadly 
weapons  for  self-protection."  The  Elizabeth  has 
a  luxurious  library,  state  and  observation  rooms, 
but  the  greatest  attention  has  been  paid  to  the 
motive  power  and  steering  apparatus.  The  boat 
on  a  smooth  course  will  easily  cover  12  miles  an 
hour.  We  wish  Dr.  Smith  much  enjoyment  from 
his  "simple  life  outing." 


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96 
97 
98 
103 
105 
114 
115 
125 
137 
141 
142 
143 
148 
149 
150 
151 
152 
153 
15S 
159 
160 
161 
162 
163 
165 
166 
167 
171 
177 
181 


S  C  =     B^S^B_.--0> 

u  <  00  ft  o  ft  o  S*  en  ft  a     ■< 

1912  75  100  85  97  80  75  78  86  90  766   85 

1911  71  75   ..   ..   65  ..  69  67  

1911  84  98   86  87  84  75  88  84  89  775   86 

1912  77  90  76  77  82  67  85  67  75  696  77 
1912  71  88  80  88  75  79  75  70  79  705  78 
1912  86  75  92  90  82  65  68  79  70  707  78 
1912  75  90  81  94  75  80  79  84  80  738  82 
1912  94  90  96  97  87  90  88  94  88  824  91 
1912  47  90  79  70  75  71  50  0  72  554  62 
1912  94  85  88  S9  75  79  75  88  85  758  84 
1912  54  85  77  79  75  75  59  67  63  634  70 
1912  80  90  88  89  75  75  67  84  68  716  80 
1912  84  90  96  92  78  80  76  74  75  745  83 
1912  87  76   93   94   76  75  S3  75  96  754   S4 

1905  75  ..   78   

....  82   88  92  ..  82   

1912  89  95  94   92  82  79  93  90  87  801   89 

....  87   94  86  ..  94   

....  87   S7  86  ..  95   

1912  75  80  91   81   83  81  78  76  79  724   80 

79  89  ^8  91 

1912  64  90  67   75  75  70  80  75  72  668   74 

....  87   89  75  ..  82   

1912  64  92   93   94   75  75  75  87  86  741   82 

....  80   82  87  ..  90   

....  89   83  81  ..  90   

1912  80  96  86  94  75  79  66  55  75  706   78 

1912  64  92  83  55  75  75  79  58  75  656   73 

1912  72  95  75  88   80  73  63  69  85  700   78 

....  83   86  90  ..  84   

1912  74  85   74   75   75  73  75  77  68  676   75 

....  65   76  57  ..  44   

1912  76  84   87   94  75  75  80  75  80  726   81 

....  87   78  67  ..  76   

....  80   79  80  ..  85   

1912  90  90   95   94   81  92  81  77  93  793   88 

....  73   80  75  ..  84   

1912  92  80  97   94   84  75  87  81  75  765   85 

1912  77  84   96   91   79  88  84  92  86  777   86 

1912  91  80  72  91  75  65  79  75  85  713   79 

....  75   82  70  ..  75   

....  63   71  54  ..  57   

....  85   81  76  ..  75   

....  84   75  75  ..  96   

1912  89  84  99   92  75  88  75  96  89  787   87 

....  90   89  66  ..  83   

1912  83  84   S5   91   82  85  86  S7  85  768   85 

1910  ..  ..   82   75  ..  78   

....  74   75  79  ..  66   

1911  76  96   95  86  ..  76  

1912  80  87  86   93   75  86  69  74  93  743   83 


The  staff  of  the  University  Hospital  for  1912- 
1913  is  as  follows: 

Medical  Superintendent — William  J.  Coleman, 
M.D.,  class  of  1908. 

Assistant  Resident  Surgeons — F.  R.  Winslow, 
M.D.,  class  of  1906;  Robert  E.  Abell,  M.D.,  class 
of  1912:  William  E.  Gallion,  Jr.,  M.D.,  class  of 
1912;  Edward  A.  Looper.  M.D.,  class  of  1912; 
Henderson  Irwin,  M.D.,  class  of  1912. 

Assistant  Resident  Physicians  —  Charles  W. 
Rauschenbach,  M.D.,  class  of  1912:  R.  A.  All- 
good,  M.D.,  class  of  1912:  Wilbur  M.  Scott, 
M.D.,  class  of  1912;  Judson  E.  Hair,  Jr.,  M.D., 
class  of  1912. 

Assistant  Resident  Gynecologists — William  L. 
Byerly,  M.D.,  class  of  191 1  :  L.  K.  Walker,  M.D., 
class  of  1911. 

Resident  Pathologist  —  M.  L.  Lichtenberg, 
M.D.,  class  of  1912. 


THE    HOSPITAL    BULLETIN 


ii7 


The  various  newspapers  of  Baltimore  are  advo- 
cating former  Governor  Edwin  Warfield  as  the 
choice  of  the  majority  of  the  officers  of  the 
University  for  Provost  to  succeed  Bernard 
Carter,  provided  he  is  able  to  give  sufficient  time 
to  the  needs  of  the  University.  The  Board  of 
Regents  meet  in  September,  and  have  as  yet  given 
no  indication  of  the  course  to  be  pursued  by  them. 


Dr.  J.  Holmes  Smith,  professor  of  anatomy  and 
clinical  surgery,  and  Dr.  J.  Howard  Maldeis,  lec- 
turer in  histology  and  embryology,  will  in  future 
devote  their  entire  time  to  teaching  and  will  dis- 
continue the  practice  of  medicine. 


Criticism  doesn't  hurt  an  institution  founded  on 
solid  merit.  Out  of  the  smoke  of  discussion  we 
may  expect  a  greater  University  of  Maryland  to 
arise. — Evening  Sun,  August  12. 


Dr.  William  Emrick,  class  of  1902,  now  located 
in  Brazil",  is  a  truest  in  Baltimore. 


Dr.  Frank  Lynn,  class  of  1907,  is  out  of  town 
because  of  ill  health. 


The  president  of  the  board  of  directors  of  the 
Skin  and  Cancer  Hospital  of  Maryland  has  an- 
nounced the  following  appointments  of  our 
alumni : 

Surgeon-in-chief,  Dr.  George  Hauer  Everhart, 
class  of  1890. 

Surgeons,  Drs.  Robert  Bay,  class  of  1905 ;  E. 
H.  Kloman,  class  of  1910,  and  Hoagland  Cook 
Davis,  class  of  1902. 

Consultants,  Drs.  Eldridge  C.  Price,  class  of 
1874;  William  Dulaney  Thomas,  class  of  1887; 
Wilbur  F.  Skillman.  class  of  1900;  Clarence  K. 
Jump,  class  of  1885,  and  George  Latrobe  Ewalt, 
class  of  1900. 


Dr.  Jurgi  Elias  Sawaya,  class  of  1910,  is  lo- 
cated at  628  San  Martin,  BuenOs  Ayres,  Argen- 
tina. 


Dr.  J.  A.  Hughes,  class  of  1909,  is  located  at 
Strong;,  Northumberland  county,  Pennsylvania. 


Dr.  William  Royal  Stokes,  class  of  1891,  is  re- 
covering from  a  severe  attack  of  malaria,  al- 
though it  will  be  some  time  before  he  is  able  to 


resume  his  work  at  the  Department  of  Health. 
The  Baltimore  Sun  writes  of  him: 

"In  addition  to  his  work  at  the  Health  Depart- 
ment, Dr.  Stokes  has  the  chair  of  bacteriology 
at  the  College  of  Physicians  and  Surgeons,  which 
is  connected  with  the  Mercy  Hospital.  He  is 
also  bacteriologist  for  the  State  Board  of  Health. 

"He  organized  the  bacteriological  laboratory 
at  the  Health  Department  soon  after  the  election 
of  Mayor  Hooper,  and  has  developed  it  gradu- 
ally as  funds  were  provided  by  the  city.  It  is 
now  regarded  as  one  of  the  best  equipped  labora- 
tories in  the  country.  Physicians  from  New 
York,  Chicago  and  other  cities  have  commended 
it.  Dr.  Stokes  devotes  all  his  time  to  the  work. 
For  some  time  he  has  been  directing  the  manufac- 
ture of  serum  for  the  prevention  of  typhoid  fever. 

"The  study  of  bacteriology  is  a  hobby  with 
Dr.  Stokes.  No  matter  how  often  the  adminis- 
tration changes  politically,  there  is  never  mention 
of  a  successor  to  him.  Health  Commissioner 
Bosley  recently  remarked,  on  being  asked  if  Dr. 
Stokes  would  retain  his  position :  'You  bet  he 
will.  I  would  almost  as  quickly  think  of  having 
no  Health  Department  as  I  would  of  having  a 
Health  Department  without  Stokes.'  " 


Dr.  Gilbert  Tyson  Smith,  class  of  1897.  was 
recently  a  guest  in  Baltimore,  and  while  stopping 
at  the  Baltimore  Athletic  Club  told  of  his  recent 
adventures  and  his  future  plans.  Dr.  Smith 
spent  last  year  along  the  eastern  coast  of  Alaska 
as  surgeon  to  the  Alaska-Canada  Boundary  Sur- 
vey. Most  of  last  winter  was  spent  at  Rampart 
House,  a  trading  post,  250  miles  up  the  Porcupine 
River,  a  tributary  of  the  Yukon.  Last  fall  an 
epidemic  of  virulent  smallpox  broke  out  among 
the  native  Indians,  and  he  was  put  in  charge  of 
the  situation  by  the  Canadian  Government.  He 
stamped  out  the  disease,  and  lost  but  one  of  the 
98  patients  suffering  with  the  disease.  To  eradi- 
cate the  germs  Dr.  Smith  destroyed  by  fire  the 
cabins  occupied  by  the  Indians,  and  even  burned 
the  hospital  which  the  Government  had  erected  at 
a  cost  of  several  thousands  of  dollars.  But  the 
necessity  for  this  severe  measure  was  so  great 
that  his  course  was  received  with  commendation 
by  Alaska  and  Canada  alike.  He  is  now  in 
<  Htawa,  Canada,  preparing  for  a  hunting  trip  in 


n8 


THE    HOSPITAL    BULLETIN 


the  far  Northwest  in  the  spring.  He  will  travel 
through  Europe  during  the  winter  months. 

For  his  trip  in  the  spring  he  has  purchased  the 
Vera,  one  time  a  San  Francisco  man's  yacht, 
Inter  an  opium  smuggling  craft,  and  perhaps  yet 
to  see  her  weirdest  adventures  under  his  guid- 
ance. The  ship  lies  in  harbor  at  Victoria,  B.  C. 
The  first  stop  will  be  Nome.  Alaska,  which  Dr. 
Smith  expects  to  reach  in  three  weeks  after  starl- 
ing. Then,  as  Dr.  Smith  says :  "Hunting  big 
game  along  the  coast,  as  well  as  inland,  we  shall 
make  our  way  gradually  north  of  Alaska  into 
the  Arctic  Ocean,  with  Ranksland  as  our  goal. 
There  we  will  camp  for  the  winter.  For  months 
we  shall  be  frozen  in,  so  to  speak,  in  the  Arctic 
night. 

"Hazardous?  Yes,  extremely  so;  but  it  ap- 
peals to  me,  and  if  I  must  die  I  should  as  soon 
be  buried  under  Arctic  ice  as  in  Greenmount 
Cemetery.  I  am  unmarried  and  footfree.  Were 
it  otherwise,  of  course  I  would  not  think  of  go- 
ing. But  it  is  no  trip  for  a  man  who  fears  a 
rough,  harsh  life,  far  beyond  the  luxuries  of 
civilization. 

"While  my  main  purpose  will  be  to  hunt,  I 
expect  to  do  some  little  exploring,  for,  if  lucky, 
I  will  reach  that  part  of  the  world  of  which  prac- 
tically nothing  is  known.  No,  I  will  not  try  for 
the  Pole,  for  I  am  a  rival  of  neither  Peary  nor 
Dr.  Cook." 


county.  Dr.  Wright  was  a  member  of  the  Phipps 
Dispensary  staff  of  Johns  Hopkins  during  the 
time  he  was  connected  with  Eudowood  Sana- 
torium. 


Dr.  Andres  Martin,  class  of  1912,  writes  from 
Havana  that  the  Cuban  situation  "is  getting  bel- 
ter every  day." 


Current  report  says  that  Dr.  Josephus  Arthur 
Wright  has  been  appointed  superintendent  of 
Sydenham  Hospital,  but  we  have  not  as  yet  been 
able  to  corroborate  the  statement.  Dr.  Wright 
is  a  graduate  of  the  class  of  1881. 

After  graduation  from  the  University  of 
Maryland  he  became  physician  in  charge  at  the 
Confederate  Soldiers'  Home,  Pikesville,  where 
he  remained  four  years.  Leaving  the  home,  he 
practiced  on  the  Eastern  Shore,  returning  10 
Baltimore  five  years  ago  to  become  assistant  resi- 
dent physician  at  Eudowood  Sanatorium.  He 
lives  with  his  son.  Dr.  Arthur  L.  Wright,  class 
(if  [908,  2505  W.  Pratt  street,  assistant  surgeon 
for  the  Baltimore  &  Ohio  Railroad  Co. 

Dr.  Wright  is  52  years  old.  He  received  his 
early  education  in  the  public  schools  of  Wicomico 


The  following  alumni  successfully  passed  the 
Maryland  State  Board  examinations  held  in 
June : 

Robert  Alexander  Bonner,  Charles  Peter 
Clautice,  John  Dade  Darby,  Harry  Deibel,  John 
William  Ebert,  Ernest  William  Frey,  Dawson 
Orme  George,  William  Granville  Haines,  Jud- 
son  Elam  Hair,  Jr.,  James  Edward  Hubbard, 
John  Kent  Johnston,  Edward  Sooy  Johnson,  Ed- 
win Paul  Kolb,  Moses  Louis  Lichtenberg,  Wil- 
liam Michel,  Benjamin  Newhouse,  Roger  Vinton 
Parlett,  Charles  William  Rauschenbach,  Jay  D. 
Sharp.  Thomas  F.  A.  Stevens,  John  Henry  Tra- 
band,  Jr.,  William  Howard  Yeager,  all  of  the 
class  of  1912. 

Alvah  Parrish  Bohannan,  class  of  1005. 

Henry  Benedict  Athey,  class  of  101 1. 

John  Francis  Bryne,  class  of  1910. 

Samuel  Hopkins  Cassidy,  class  of  1911. 


Dr.  Thomas  Boyle  Owings  is  seriously  ill  at 
his  home,  Owings  Glen,  near  this  city.  Dr. 
Owings  was  born  at  Roxbury  Mills.  September 
24.  1830.  He  was  the  son  of  the  late  Dr.  John 
Hood  and  Mrs.  Amanda  Clementine  Owings. 
He  was  educated  in  the  public  schools  of  this 
county,  and,  after  reading  medicine  under  his 
father,  entered  the  University  of  Maryland,  from 
which  he  graduated  in  1852  with  high  honors. 
He  first  located  on  the  Baltimore  county  side  of 
Ellicott  City  shortly  after  he  graduated.  He 
served  as  County  Commissioner  for  about  2$ 
years.  Dr.  Owings  was  twice  married.  His  first 
wife  was  Miss  Margaretta  Clark,  daughter  of  the 
late  David  and  Maria  Clark,  of  Howard  county, 
and  his  second  wife,  who  is  now  living,  was 
Miss  Nellie  Polk,  daughter  of  the  late  Col.  Wil- 
liam C.  Polk,  formerly  of  Delaware,  and  Mrs. 
Sarah  A.  Polk,  who  now  resides  at  Sykesville, 
Carroll  county,  and  who  is  in  her  93d  year. 

In  1868,  the  time  of  the  great  flood  along  the 
Patapsco  River,  when  the  larger  portion  of  Elli- 
cott City  was  washed  away.  Dr.  Owings'  first 
wife,  six  children  and  several  servants,  together 
with  his  house  and  contents,  were  washed  down 
the  river  by  the  raging  waters.  The  present  Mrs. 
Clarence  W.  Watson  of  West  Virginia,  wife  of 


THE    HOSPITAL    BULLETIN 


119 


Senator  Clarence  \V.  Watson,  and  Dr.  Clark 
<  Iwings  of  Boston,  Mass.,  were  the  only  mem- 
bers of  Dr.  Owings'  family  except  himself  to 
escape  death  at  this  time,  and  the  reason  for  this 
was  that  they  were  away  from  home,  visiting  at 
their  grandfather's.  Dr.  ( >wings  was  away  an- 
swering a  professional  call,  and  arrived  at  the 
bank  on  the  Patapsco  just  in  time  to  see  his 
house,  with  his  family  and  servants  sitting  on 
the  roof,  carried  down  by  the  flood.  Dr.  Owings 
was  almost  crazed  with  grief,  and  it  took  the  best 
efforts  of  those  along  the  river  to  prevent  the 
doctor  from  plunging  into  the  flood  in  a  useless 
attempt  to  save  those  that  were  clear  to  him. 

Dr.  Owings  retired  from  active  practice  in 
[9]  1,  owing  to  ill-health,  but  at  that  time  he  hail 
rounded  out  60  years  as  a  practicing  physician. 

We  sincerely  wish  for  Dr.  ( Iwings  a  restoration 
to  health  and  usefulness  in  the  community  he  has 
helped  so  many  years. 


Dr.  Thomas  J.  Murray  has  opened  an  office  at 
104  East  Main  street.  Meriden,  Conn. 


The  staff  of  nurses  of  the  Annapolis  Emer- 
gency Hospital  resigned  in  a  body  July  31.  Miss 
Rosamond  Minnis,  University  Training  School 
for  Nurses,  class  of  1907,  who  led  the  retiring 
body,  had  been  in  charge  of  the  hospital  for  some 
time.  She  will  become  superintendent  of  the 
Atlantic  Coast  Line  Hospital  at  Rocky  Mount. 
N.  C.  Miss  Alice  Frances  Hell,  University  Hos- 
pital Training  School  for  Nurses,  class  of  1907, 
will  succeed  Miss  Minnis  as  superintendent  of 
the  Annapolis  Emergency,  entering  upon  her 
duties  September  1. 


Dr.  Ralph  Steiner,  class  of  1883.  607  W.  7th 
street,  Austin.  Tex.,  is  president  of  the  State 
Board  of  Health  of  the  State  of  Texas,  with  head- 
quarters in  Austin. 


year.  Dr.  Stallworth  has  just  passed  with  a  more 
than  creditable  average  the  examination  of  the 
State  Examining  Board  of  Medical  Licensure 
for  Alabama. 


Dr.  Claude  Jackson  Stallworth,  class  of  10 1-2. 
of  Beatrice,  Ala.,  has  been  elected  resident  phys- 
ician of  the  Presbyterian  Eye.  Ear  and  Throat 
Hospital  of  Baltimore,  succeding  Dr.  William 
( iee.  resigned.  Dr.  Stallworth  was  educated  in 
the  public  schools  of  Alabama  and  the  Daphne 
State  Normal  College,  graduating  there  with 
honors  in  K)o8.  He  then  studied  three  years  in 
the  Atlanta  College  of  Physicians  and  Surgeons, 
entering  the  University  of  Maryland  in  his  senior 


Dr.  Charles  Wesley  Roberts,  class  of  [906,  of 
Douglas.  Ga.,  sent  us  "case  report  for  The  Bul- 
letin', check  for  two  years'  subscription  to  The 
Bulletin  and  best  wishes  for  all  my  teachers 
and  friends  connected  with  the  University."  A 
fat  envelope  like  that  gladdens  the  hearts  of  the 
recipients  and  all  who  know  its  contents. 


MARRIAGES 


Dr.  Gains  William  Billups,  class  of  1906,  of 
2224  W.  North  avenue,  was  married  July  24. 
1912,  to  Mrs.  Josephine  Long,  daughter  of  Capt. 
G.  M.  Mullin.  The  ceremony  was  performed 
at  the  Church  of  the  Prince  of  Peace,  Walbrook, 
the  assistant  rector,  Rev.  James  Grattan  Mythen, 
officiating.  The  bride  wore  a  blue  serge  travel- 
ing dress,  with  hat  to  match,  and  was  attended  by 
her  sister.  Mrs.  Nathaniel  G.  Sexton,  as  matron 
of  honor.  The  best  man  was  Dr.  Edgar  Shirley 
Perkins,  class  of  1907.  A  wedding-breakfast  was 
served  at  the  home  of  the  bride's  sister,  Mrs. 
William  J.  Brown.  The  couple  left  for  a  wed- 
ding trip  to  Cape  May,  and  will  reside  at  2224 
W.  North  avenue  upon  their  return. 


Dr.  Louis  Harriman  Douglass,  class  of  191 1. 
a  resident  physician  of  the  University  Hospital, 
and  Miss  Helen  Rowles  of  Parksley,  Accomac 
county,  Virginia,  were  married  at  Towson  on 
Tuesday,  July  30,  1912.  The  ceremony  was 
performed  by  Rev.  W.  H.  H.  Powers,  rec- 
tor of  Trinity  Protestant  Episcopal  Church. 
Mr.  and  Mrs.  J.  S.  Downing  served  as  attend- 
ants. The  bride  was  a  guest  of  Dr.  Douglass' 
parents,  having  come  to  Baltimore  to  attend  the 
Democratic  Convention.  She  and  Mrs.  Downing 
were  students  together  in  the  Nurses'  Training 
School  of  the  Maryland  Homeopathic  Hospital. 
Dr.  and  Mrs.  Douglass  were  the  attendants  at 
the  wedding  of  the  Downings  last  December. 


Dr.  John  Joseph  Carroll,  class  of  1905,  of  185 
Chestnut  street,  Holyoke.  Mass.  (  formerly  of 
120  Chestnut  street),  was  married  June  15,  [905, 
to  Miss  Joanne  Marie  Sullivan.  There  were  no 
cards,  the  wedding  being  very  quiet,  owing  to 
illness  in  the  familv  of  the  bride. 


120 


THE    HOSPITAL    BULLETIN 


Dr.  James  Edward  Hubbard,  class  of  1912, 
and  Miss  Lillian  E.  Godwin,  daughter  of  Mr.  and 
Mrs.  James  C.  Godwin  of  Easton,  Md.,  were 
married  on  July  17,  1912,  at  6  A.  M.,  at  the  home 
of  the  bride's  parents  in  Watson,  the  Rev.  W.  II . 
Litsinger  of  Calvary  Methodist  Church  officiat- 
ing. The  ceremony  was  witnessed  by  the  imme- 
diate relatives  only.  A  wedding  breakfast  was 
served  at  the  house,  and  the  couple  left  on  the 
early  morning  train  for  the  North.  They  will 
reside  in  Easton  until  October  1,  when  they  will 
remove  to  Baltimore,  and  Dr.  Hubbard  will  en- 
ter upon  his  duties  as  resident  physician  in  the 
James  Lawrence  Kernan  Hospital  for  Crippled 
Children. 


DEATHS 

Dr.  John  Addison  Moorman,  class  of  1868, 
Bellevue  Hospital  Medical  College,  '7^,  a  member 
of  the  Medical  Society  of  Virginia,  formerly  of 
Haleford,  Ya.,  died  at  his  home  at  Hendrick's 
Store,  Ya.,  July  16,  1912,  from  nephritis,  aged 
68  years. 


George  R.  Patrick,  class  of  1879,  a  member  of 
the  A.  M.  A.  and  a  practitioner  of  high  rank  in 
Gaston  county,  X.  C.,  died  at  his  home  in  Lowell 
June  19  from  cerebral  hemorrhage,  aged  57  years. 


We  regret  exceedingly  to  announce  the  death 
of  Mrs.  Nora  Gorman  Ballenger,  wife  of  Dr. 
Edgar  Garrison  Ballenger,  class  of  1901,  of  At- 
lanta, Ga.,  July  18,  1912.  Mrs.  Ballenger  was  a 
daughter  of  Mr.  William  H.  Gorman  of  Catons- 
ville,  and  a  niece  of  the  late  Senator  Arthur  Gor- 
man of  Maryland.  She  married  Dr.  Ballenger 
in  April,  1904.  Death  was  due  to  typhoid,  from 
which  Mrs.  Ballenger  had  been  ill  for  several 
weeks.  Interment  was  in  Loudon  Park  Ceme- 
tery. She  is  survived  by  her  husband  and  a  little 
son  and  daughter. 


Dr.  John  Barron,  class  of  1877,  died  at  his 
home,  2236  Barclay  street,  August  3,  1912,  of 
heart  failure.  Dr.  Barron  was  born  in  Clonmell. 
Ireland,  March  26,  1843.  His  parents  emigrated 
to  America  in  1845.  ^e  was  educated  at  Loyola 
College  and  St.  James'  Institute,  matriculating 
at  the  University  in  1844.  lie  practiced  for  a 
time  in  Philadelphia,  later  locating  in  Govans- 
town,  where  he  practiced  for  over  30  years,  lie 
is  survived  by  a   widow  and  three  daughters — 


Misses  Katherine  T..  Elizabeth  D.  and  Marie  M. 
Barron. 

Dr.  Barron  was  buried  on  Tuesday,  August 
6,  requiem  mass  being  celebrated  at  St,  Ann's 
Catholic  Church  by  Rev.  Lucius  Johnston. 
Burial  was  in  St.  Mary's  Cemetery  at  Govans- 
town. 


William  Porsons  lvey,  class  of  1883.  died  at 
his  home  in  Lenoir,  N.  C,  June  28,  1912,  from 
cerebral  hemorrhage,  aged  55  years.  Dr.  lvey 
was  for  many  years  assistant  superintendent  of 
the  Morgantown  State  Hospital  and  a  member 
of  the  State  Board  of  Health.  He  was  a  member 
of  the  Medical  Society  of  the  State  of  North 
Carolina. 


Dr.  Henry  Rowland  Walton,  class  of  1850,  for 
60  years  a  practitioner  of  medicine  in  Annapolis, 
died  shortly  before  midnight  August  8,  1912,  at 
his  home  on  Francis  street  of  general  debility. 
Dr.  Walton  was  born  in  St.  Mary's  county  Feb- 
ruary 29,  1828,  the  son  of  the  late  Col.  John  Wal- 
ton and  Mary  Egerton  Duke.  On  his  mother's 
side  he  was  a  direct  descendant  of  Leonard  Cal- 
vert and  of  Duke,  who  came  to  Maryland  with 
Leonard  Calvert  on  the  Ark  and  Dove  in  1634. 
lie  was  84  years  old.  He  graduated  from  St. 
John's  College  in  1847  and  from  the  medical 
school  of  the  University  of  Maryland  in  1850. 
Then  he  spent  two  years  under  Professor  Charcot 
in  I'aris.  He  returned  to  Annapolis  and  began 
active  practice,  which  was  uninterrupted  until 
he  became  too  feeble  to  attend  to  his  patients. 
It  is  said  that  Dr.  Walton  was  one  of  the  first,  if 
not  the  first,  physician  in  Maryland  to  administer 
an  anesthetic.  He  married  Miss  Julia  Ballard 
Kent,  daughter  of  Governor  Kent  of  Maryland, 
She  died  some  years  ago.  His  surviving  children 
are  Misses  Catharine  and  Agnes  Walton  and 
Messrs.  J.  Alphonsus  and  Lawrence  Walton,  all 
of  Annapolis.  He  was  buried  from  St.  Mary's 
Catholic  Church,  Annapolis,  Monday,  August  10. 


John  W.  Field,  M.D.,  class  of  i8fto,  for  many 
years  postmaster  of  Chincoteague  Island,  Ya., 
a  member  of  the  Virginia  Legislature  from  1865 
to  1867  and  at  one  time  a  member  of  the  Mary- 
land and  Yirginia  Boundary  Commission,  died  at 
his  home  on  Chintoteague  Island.  May  4.  1912, 
aged  75  years. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  o£  the  Medical  Department  of  the  University  o£  Maryland 
PRICE    $1.00    PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  608  Professional  Building,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.  VIII 


BALTIMORE,  MD.,  SEPTEMBER  15,   1912. 


No.  7 


A   SUMMER  CRUISE  ON  THE  SPANISH 
.MAIN. 


r>v  Randolph  Winslow,  M.D. 


1.     New  York  to  Colon  via  Jamaica. 

Colonel  Goethals,  the  chief  engineer  of  the 
Panama  Canal,  several  months  ago  gave  notice, 
that  those  who  wished  to  see  the  construction 
work  of  the  canal  before  the  water  was  turned 
in  would  have  to  be  in  a  hurry  to  do  so,  as  the 
actual  work  of  excavation  was  practically  fin- 
ished. This  is  therefore  my  excuse  for  making 
a  trip  to  the  tropics  in  midsummer.  As  a  matter 
of  fact,  I  found  I  had  chosen  the  most  favorable 
time  for  visiting'  the  Isthmus  and  the  adjacent 
lands.  There  are  four  steamship  lines  plying 
between  New  York  and  Colon,  but  I  have  no  re- 
gret in  having  chosen  the  Hamburg-American 
Line  steamship,  Prinz  August  Wilhelm  for  the 
voyage.  The  ship  is  staunch  and  comfortable, 
though  not  speedy.  The  officers  are  vigilant, 
capable  and  affable,  and  the  cuisine  is  excellent 
and  abundant.  The  staterooms  are  large,  and  are 
kept  cool  with  electric  fans,  and  every  effort  is 
made  to  keep  the  passengers  contented  and 
happy.  Promptly  at  2  P.  M.  on  July  13,  1912,  the 
hawsers  were  cast  off,  and  we  started  on  our 
25- day  cruise.  To  my  surprise,  the  passenger  list 
was  quite  large,  and  consisted  of  a  number  of  per- 
sons returning  to  their  work  in  Cuba  and  the 
Canal  Zone,  as  well  as  tourists,  salesmen,  natives 
of  the  Spanish-American  countries  and  travelers 
of  various  races  and  tongues.  Passing  down 
the  Jersey  coast,  the  Barnegat  light  blinked  us  a 
cheerful  bon  voyage,  and  for  the  next  four  days 
we  pursued  an  almost  due  southern  course  upon 
a  smooth  sea.  passing  San  Salvador,  or  Watling's 
Island,  which  is  supposed  to  have  been  the  first 
land  discovered  by  Columbus  in  1492,  early  on 
the  morning  of  July  17.     Some  hours  later  we 


came  to  a  stop  at  Fortune  Island,  one  of  the  Ba- 
hamas, where  we  took  on  36  negro  laborers,  as 
well  as  fresh  fish.  This  is  a  small  island  inhabited 
almost  entirely  by  blacks,  who  eke  out  an  exist- 
ence by  fishing  and  serving  as  stevedores  on  the 
ships.  These  men  are  taken  aboard  when  the 
ships  go  south,  and  are  put  off  on  the  return  trip, 
after  having  earned  enough  ready  money  to  meet 
I  heir  needs  for  several  weeks.  The  scene  from 
the  ship  is  very  pretty ;  the  green  foliage  of  the 
island  in  a  setting  of  marine  blue,  the  white 
houses  embowered  in  palm  groves,  and  the  hurry- 
ing boats  filled  with  dark-skinned  natives,  made  a 
typical  tropical  picture.  We  did  not  go  ashore, 
however,  and  soon  the  rythmical  chug  of  our  pro- 
peller indicated  that  we  were  again  on  the  move. 
The  short  stop,  however,  was  an  agreeable  break 
in  the  monotony  of  the  voyage.  After  passing 
Castle  Rock  Lighthouse  we  were  again  in  the 
open  ocean,  and  the  fresh  southeast  trade  winds 
kicked  up  a  rough  sea.  The  Bahamas  are  a  large 
group  of  small  islands  lying  off  the  coast  of  Flor- 
ida and  the  eastern  end  of  the  Gulf  of  Mexico, 
belonging  to  Great  Britain  and  inhabited  mostly 
by  negroes.  They  are  said  to  be  delightful  places 
in  which  to  spend  a  winter  vacation,  with  an 
abundance  of  wild  fowl  for  the  hunter  and  waters 
teeming  with  splendid  fish.  We  were  now  ap- 
proaching the  coast  of  Cuba,  and  Cape  Maysi, 
the  extreme  eastern  end  of  the  island,  was  passed 
in  the  night.  Early  on  the  morning  of  July  18 
we  were  running  along  the  desolate-looking  and 
rugged  southern  coast  of  the  province  of  Oriente, 
made  famous  by  the  blockade  of  the  American 
fleet  in  1898.  About  9  o'clock  we  passed  through 
the  narrow  entrance  to  Santiago  harbor,  and 
shortly  thereafter  cast  anchor.  Owing  to  a  quar- 
antine declared  by  Jamaica  against  Cuba  on  ac- 
count of  a  few  cases  of  plague  at  Havana,  we 
were  not  allowed  to  land,  and  we  spent  the  day, 
like  Moses,  viewing  the  promised  land  from  afar. 
This  was  much  to  be  regretted,  as  Drs.  Infante, 


122 


THE   HOSPITAL   BULLETIN 


Brooks  and  Sagebien  came  out  in  a  motor-boat 
to  meet  us.  and  they  could  neither  board  the  ship 
nor  could  we  accept  their  highly  appreciated  cour- 
tesy. Passengers  who  did  not  expect  to  go  far- 
ther on  the  ship  were  permitted  to  land.  From 
y  in  the  morning  to  6  in  the  evening  we  lay  in  the 
harbor  unloading  freight  into  scows,  and  then 
made  a  bee-line  for  Kingston.  Jamaica.  'When  I 
reached  the  deck  early  the  next  morning  the 
mountainous  coast  of  Jamaica  was  in  full  sight, 
and  not  long  thereafter  Kingston  harbor  was  ap- 
proached. The  coast  here  is  dangerous,  and  sev- 
eral wrecks  were  in  sight.  Kingston  is  situated 
on  a  bay  which  is  separated  from  the  sea  by  a 
long  sickle-shaped  spit  of  land  forming  almost  a 
semi-circle  several  miles  in  length  and  only  a  few 


Steaming  up  the  harbor  we  passed  the  United 
Fruit  steamer  Mandeville  hard  aground  on  a 
sand  bar,  and  upon  our  return  two  weeks  later 
we  found  her  in  the  same  unfortunate  predica- 
ment. We  landed  at  Kingston  about  9.30  A.  M., 
and  were  almost  at  once  surrounded  by  a  clamor- 
ing mob  of  dusky  coachmen,  who  were  most  per- 
sistent in  their  solicitations,  and  would  not  take 
"no"  for  an  answer.  Their  favorite  expression 
was,  "Doc.  here  is  your  carriage,"  or  "Take  you 
up.  Doc.  ?"  I  do  not  know  why  they  suppose  all 
the  white  male  passengers  from  the  ships  to  be 
doctors.  The  weather  was  hot,  and  as  there  had 
been  no  rain  for  nearly  six  months,  the  streets  and 
foliage  were  white  with  dust.  The  city  was 
almost  entirely  destroyed  by  earthquake  and  fire 


KING  STREET,    LOOKING    NORTH.    KINGSTON.    JAMAICA. 


hundred  feet  in  width.  This  acts  as  a  break- 
water, and  never  mind  how  rough  the  water  is  on 
the  outside,  ships  are  safe  when  in  the  harbor. 
(  In  the  end  of  this  tongue  of  land  is  situated  Port 
Royal,  formerly  a  large  town  of  ill-repute,  but 
after  various  catastrophies  by  earthquakes  and 
otherwise,  it  is  now  only  a  British  military  and 
naval  establishment.  About  200  years  ago  Port 
Royal  was  destroyed  by  an  earthquake,  and  a 
large  portion  of  its  site  was  submerged  in  the  sea. 
There  is  a  tradition,  probably  apocryphal  in  char- 
acter, that  for  a  long  time  the  houses  could  be 
seen  at  the  bottom  of  the  sea  as  ships  passed  over 
them.  We  were  subjected  to  a  rigid  quarantine 
examination,  but  were  permitted  to  land,  and  in 
that  respect  were  more  fortunate  than  the  pas- 
sengers of  the  Prinz  Joachim,  of  the  same  line, 
who  were  held  up  several  days  two  weeks  later. 


two  or  three  years  ago,  but  the  houses  have  been 
rebuilt  with  reinforced  concrete,  hence  are  sup- 
posed to  be  both  fire  and  quake  proof.  The  busi- 
ness houses  and  public  buildings  are  quite  fine 
structures,  and  the  residences  are  pretty  bunga- 
lows surrounded  by  beautiful  flowers  and  vines. 
The  Myrtle  Bank  Hotel  is  a  large  structure  of 
the  Spanish  mission  style  of  architecture,  beauti- 
fully situated  on  the  bay,  where  the  fresh  sea 
breeze  blows  constantly  during  the  day  and  a  land 
breeze  at  night.  We  had  an  opportunity  to  attend 
a  dance  at  the  hotel,  and  to  see  fashionable  society 
in  this  colonial  metropolis.  The  guests  at  this 
function  were  all  white,  the  ladies  were  dressed  in 
the  height  of  style,  and  some  of  them  were  very 
handsome,  and  the  gentlemen  were  fine-looking 
men,  who  looked  very  uncomfortable  in  full-dress 
suits.     Dancing  was  evidently  hot  work,  as  there 


THE    HOSPITAL    BULLETIN 


123 


were  long  intermissions  between  the  dances,  dur- 
ing which  the  parties  sat  under  the  trees  and 
cooled  off.  The  population  of  Jamaica  is  98  per 
cent,  negro,  varying  from  nearly  white  to  jet 
black  in  color.  Many  of  them  are  good-looking, 
well  dressed  and  educated,  the  majority,  however, 
are  plain  "niggers."  Negro  women,  barefooted 
and  scantily  attired,  come  long  distances,  carry- 
ing large  baskets  filled  with  vegetables  and  fruits 
on  their  heads,  or  driving  diminutive  donkeys  so 
heavily  laden  with  produce  as  to  almost  hide  the 
animals  from  sight.  The  stores  are  good,  and 
merchandise  is  reasonable  in  price,  owing  to  the 
absence  of  duty.  The  clerks,  and  often  the  pro- 
prietors, are  mulattoes,  but  one  receives  polite  at- 
tention and  good  service. 


I  embarked  in  one  of  the  latter  craft  and  drove 
around  the  city.  As  has-  been  said,  the  long-con- 
tinued drought  has  parched  the  foliage  and  caused 
much  dust  and  discomfort,  but  wherever  there 
was  water  the  flowers  were  abundant  and  the 
yards  attractive.  The  Governor  lives  on  the  edge 
of  the  city  at  the  King's  House,  which  is  a  new 
concrete  building  erected  since  the  earthquake. 
Here  in  a  spacious  home,  with  large,  airy  rooms 
tilled  with  solid  mahogany  furniture,  a  splendid 
swimming  pool  and  ballroom,  and  beautiful  lawns 
and  grounds,  His  Excellency  is  able  to  pass  away 
the  time  in  a  pretty  comfortable  manner.  The 
policemen  are  all  negroes,  and  not  only  do  they 
perform  their  duties  effectively,  but  they  are  very 
striking-looking  in  their  uniforms  of  white  coats 


HARBOUR    STREET,    KINGSTON,    JAMAICA. 


One  local  custom  is  somewhat  embarrassing 
and  inconvenient  to  visitors,  especially  those 
whose  stay  is  very  limited,  and  that  is  the  closing 
of  stores  at  4  P.  M.  Upon  our  return  trip  a  num- 
ber of  passengers  wished  to  make  purchases,  but 
we  arrived  just  as  the  stores  were  closing,  and  as 
the  next  day  was  a  holiday,  we  were  unable  to 
spend  some  of  Uncle  Sam's  good  money  and  had 
to  bring  it  back  with  us.  I  may  say  here  that 
American  money  passes  current  everywhere  in 
these  parts,  and  when  they  give  the  price  as  so 
much  "gold,"  it  means  our  currency,  whether  coin 
or  bank  bills.  There  are  several  street-car  lines, 
and  one  can  get  a  good  idea  of  the  appearance  of 
the  city  and  of  the  people  by  investing  a  few  pen- 
nies in  car  rides,  or,  better  still,  by  taking  one  of 
the  rattling  vehicles  drawn  by  rat-like  ponies. 
Being  enticed  by  the  siren  song  of  a  dusky  Jehu, 


and  helmets  and  dark  blue  pantaloons,  with  broad 
red  stripes  down  the  legs.  I  saw  two  of  them 
haling  a  young  buck  to  the  lock  up;  the  police- 
man seemed  to  enjoy  the  occasion,  but  the  culprit 
was  wailing  loudly.  Tropical  fruits  in  abundance 
are  to  be  had  at  a  small  cost,  cocoanuts  just  off  the 
trees,  pineapples  just  plucked  and  sweet  as  honey, 
mangoes,  alligator  pears  and  other  fruits  that  are 
but  seldom  seen  in  our  country.  On  the  other 
hand,  lemons  are  not  to  be  had,  and  limes  are 
used  instead,  and  oranges  are  scarce.  The  great 
fruit  product  of  Jamaica,  however,  is  the  banana, 
and  an  enormous  traffic  is  carried  on  in  this  pala- 
table and  valuable  food  fruit.  The  loading  of  a 
fruit  ship  with  bananas  at  Kingston  is  a  sight  not 
Id  be  forgotten  when  once  seen.  We  took  on 
27,000  bunches  of  bananas  at  Kingston.  They 
are  harvested  when  still  very  unripe,  green  and 


124 


THE    HOSPITAL    BULLETIN 


hard,  and  are  brought  in  trains  to  the  dock ;  here 
they  are  unloaded  and  carried  by  negro  men  and 
women  on  their  heads  to  the  ship,  where  they  are 
piled  up  carefully  in  refrigerated  holds.  These 
banana  loaders  are  mostly  as  black  as  coal,  wear 
a  minimum  of  ragged  clothing,  and  sing  and 
curse  and  babble  in  a  jargon  that  is  unintelligible 
to  the  visitor.  They  frequently  stop  to  quarrel, 
and  sometimes  to  fight,  and  during  our  visit  a 
number  of  women  got  one  of  the  foremen  down 
and  gave  him  a  good  beating.  The  foremen  also 
are  impartial,  and  club  the  women  as  freely  as 
thev  do  the  men.  Several  hundred  of  these  peo- 
ple lying  like  animals  on  the  wharf  asleep,  or  later 
shouting,  singing  and  cursing,  as  well  as  polluting 
the  atmosphere  with  malodorous  effluvia,  made  a 
Plutonic  scene  indeed.  While  standing  on  the 
deck  waiting  for  the  ship  to  leave  I  was  addressed 
by  a  gentleman  who  recognized  me,  but  whom  I 
did  not  know.  He  was  Dr.  Mindis,  a  graduate 
of  the  Dental  School,  who  is  living  and  practicing 
his  profession  in  Kingston. 

The  trip  from  Kingston  to  Colon  takes  about  48 
hours,  and  is  by  no  means  a  pleasant  one,  as  the 
Caribbean  Sea  is  always  a  rough  stretch  of  water, 
and  many  people  pay  tribute  to  Xeptune.  I  did 
not  miss  any  meals  or  pay  the  above-mentioned 
tribute,  but  I  was  glad  to  see  the  shores  of  the 
Isthmus  on  the  morning  of  July  22,  and  to  dis- 
embark at  Colon  a  few  hours  later. 


THE  TREATMENT  OF  ANEURISMS  OF 
THE  ARCH  OF  THE  AORTA  AND  OF 
THE  INNOMINATE  ARTERY  BY  THE 
INTRODUCTION  OF  FOREIGN  BOD- 
IES INTO  TFIE  SAC. 


Among  the  University  alumni  practicing  in 
the  District  of  Columbia  are : 

Washington — Francis  B.  Bishop,  class  of  1883, 
1913  I  street  N.  W. ;  Edward  M.  Blackwell,  class 
of  1890,  Lieutenant-Commander,  U.  S.  N.,  care 
Navy  Department;  Rupert  Blue,  class  of  1892, 
Surgeon,  U.  S.  P.  H.  and  M.  H.  S. ;  Wm.  Sinclair 
Bowen,  class  of  1888,  Stoneleigh  Court,  Connec- 
ticut avenue  and  L  street. ;  Albert  Joseph  Carrico, 
class  of  1896,  2903  14th  street  N.  W. ;  Francis 
Miles  Cbisholm,  class  of  1889,  1632  Rhode  Island 
avenue  N.  W. ;  Horace  Benjamin  Coblentz,  class 
of  1896,  1432  U  street  N.  W. ;  George  Robert  Lee 
Cole,  class  of  1887,  418  7th  street  S.  W. ;  George 
Wythe  Cook,  class  of  1869,  3  Thomas  Circle 
N.  W. :  Louis  W.  Crampton,  class  of  1869,  Col- 
onel M.  C,  U.  S.  A.,  care  Adjutant-General's 
office  ;  Frederick  L.  Darrow,  class  of  1910,  interne 
Providence  Hospital:  Henry  D.  Fry.  class  of 
1876.  [929  [9th  street  N.  W.;  A.  W.  Valentine, 
class  of  1904,  606  N.  Carolina  avenue  S.  E. 


By  Reese  A.  Ai.lgood,  '12,  Senior  Medical 
Student. 


We  have  had  recently  a  very  interesting  case 
of  aneurism  of  the  transverse  aorta  in  this  hospi- 
tal, which  was  treated  with  good  temporary  re- 
sults by  the  Moore-Carradi  method.  This  was  a 
case  of  nine  months'  duration  in  a  man  46  years 
of  age. 

This  case  belongs  to  the  class  of  aneurisms  with 
physical  signs,  for  the  tumor  is  easily  recognized 
by  inspection,  although  there  are  a  few  pressure 
symptoms  present.  For  example,  for  about  three 
weeks  before  the  appearance  of  the  tumor  he  had 
a  constant  cough ;  also  he  had  some  difficulty  in 
breathing  and  swallowing.  A  few  attempts  have 
been  made  to  induce  coagulation  of  the  blood  in 
an  aneurism  by  the  permanent  or  temporary  intro- 
duction of  foreign  bodies,  such  as  wire,  needles, 
horse  hair,  catgut,  etc.,  into  the  sac.  The  method 
rests  upon  the  well-known  fact  that  if  freshly 
drawn  blood  be  whipped  with  a  bundle  of  fine 
rods  the  fibrin  collects  upon  them.  The  first  case 
of  permanent  introduction  of  foreign  bodies  was 
that. of  Moore  (1864)  ;  this  was  a  large  aneurism 
of  the  arch  of  the  aorta  which  had  destroyed  part 
of  the  bony  wall  of  the  thorax  and  threatened  to 
rupture  the  skin.  He  introduced  through  a  fine 
cannula  twenty-six  feet  of  fine  iron  wire,  mov- 
ing the  cannula  about  so  as  to  coil  the  wire  within 
the  sac;  coagulation  promptly  followed  and  pulsa- 
tion ceased  for  a  time,  but  inflammation  set  in, 
pulsation  returned  and  the  patient  died  on  the 
fifth  clay. 

On  March  2^,  1871,  Dr.  Dornville  introduced 
14  inches  of  fine  iron  wire  into  an  aneurism  of 
the  aorta  that  projected  through  the  sternum. 
The  tumor  became  firmer,  but  continued  to  in- 
crease in  size,  and  on  April  9  he  introduced  nine 
needles  each  two  and  one-half  inches  long.  Fatal 
hemorrhage  occurred  on  the  23d.  The  needles 
and  the  wire  were  found  in  a  dark  fibrinous 
coagulum. 

In  April.  1872,  Mr.  Murray  presented  a  patient 
to  the  Roval  Medical  and  Chirurgical  Societv  and 


THE   HOSPITAL   BULLETIN 


125 


read  an  account  of  three  other  cases  all  treated  by 
this  method. 

In  the  first  case  an  aneurism  of  the  aorta  and 
innominate,  eighteen  or  twenty  needles  were  in- 
troduced and  left  in  for  24  hours.  Then  24  feet 
of  wire  were  inserted.  The  patient  had  no  symp- 
toms, but  died  suddenly  two  weeks  after  the  last 
attempt. 

Case  II.  Aneurism  of  aorta.  Needles  were  in- 
serted at  two  different  times,  erysipelas  began  at 
the  puncture  and  caused  death. 

Case  III.  Aneurism  of  aorta  and  innominate. 
Twenty  feet  of  catgut  were  inserted,  and  at 
autopsy  it  was  found  softened  with  no  coagula 
upon  it. 

Case  IV.  The  one  shown  to  the  society  was  a 
sacular  aneurism  of  the  subclavian.  Five  or  six 
trials  of  complete  transfixion  with  20  or  30  long 
needles  for  several  hours  were  followed  each  time 
by  consolidation,  lessening  of  size  and  relief  of 
pain. 

Dr.  Lewis  introduced  24  feet  of  horse  hair  into 
an  aneurism  of  the  right  subclavian  afterwards 
without  any  beneficial  result. 

In  January,  1879,  Mr.  Christopher  Heath  in- 
troduced three  pairs  of  fine  sewing  needles,  mak- 
ing each  pair  cross  in  an  aneurism  of  the  left  sub- 
clavian artery.  The  needles  were  withdrawn  on 
the  fifth  day  and  the  tumor  became  solid.  The 
patient  died  a  few  days  later  of  bronchitis  and  the 
aneurism  was  found  full  of  dense  fibrins. 

In  1890  McEwen's  practice  for  inoperable 
aneurism  consisted  in  the  introduction  of  a  long 
needle  into  the  aneurism  tumor,  where  it  re- 
mained 24  hours,  during  which  the  needle  was 
moved  sufficient  to  scratch  the  intima  and  pro- 
duce sufficient  irritation  to  induce  the  formation 
of  a  white  fibrin  thrombus.  This  method  is  very 
uncertain. 

In  1870  Carradi,  like  Moore,  introduced  into 
an  aneurism  40  c.  m.  of  wire,  and  then  con- 
nected the  extremity  of  the  wire  with  the  positive 
pole  of  a  battery,  the  negative  being  applied  to 
the  neighborhood  of  the  aneurism ;  he  failed,  and 
so  did  his  immediate  followers. 

I  limner  of  this  city,  in  a  careful  study  and 
compilation  of  the  reported  cases  treated  by  this 
method  up  to  1900,  combining  the  statistics  of 
the  thoracic  and  abdominal  cases,  collected  14 
cases  in  which  Moore's  method  of  wiring  alone 
had  been  adopted.  Of  these  14  cases.  8  were 
thoracic  and  6  were  abdominal.     Two  of  the  ab- 


dominal cases  were  apparently  cured  (14  per 
cent,  recoveries.) 

With  the  combined  method  (Moore-Carradi ) 
there  are  23  cases — 17  thoracic  and  6  abdominal. 
Four  of  these,  or  17  per  cent.,  recovered,  includ- 
ing three  thoracic  and  one  abdominal. 

Since  Carradi  introduced  the  combined  method 
in  1879  great  improvements  in  the  technic  have 
been  made,  especially  by  American  and  British 
surgeons,  who  have  applied  this  treatment  more 
often  than  those  of  other  countries.  The  chief 
improvement  lies  in  the  better  wire;  the  silver 
wire  best  not  to  exceed  No.  28  gauge  (0.0085 
mil.)  in  diameter.  Gold  wire  is  preferred  by 
Stewart  of  Philadelphia ;  silver  blended  with  cop- 
per alloy  is  preferred  by  Finney  and  Hunner. 
Some  use  only  10  feet  of  wire,  while  others  use 
30  to  50  feet.  Also  the  number  of  milliampheres 
varies,  as  Finney  says  he  never  uses  more  than 
70,  while  Keen  says  he  has  used  as  much  as  200 
without  appreciable  bad  affects. 

D'Arcy  Powers,  1903,  improved  the  technic  by 
utilizing  an  apparatus  devised  by  G.  H.  Catt. 
This  consists  in  a  closely  packed  wire  which  is 
twisted  through  a  fine  canula  previously  intro- 
duced into  the  sac,  where  it  expands,  thereby  in- 
suring a  better  distribution  of  the  wire  network 
and  reducing  very  greatly  the  time  required  to 
insert  many  inches  of  wire. 

Case  I.  Name,  T.  P. ;  age,  46 ;  occupation, 
laborer ;  married ;  complaint,  a  tumor  in  the  neck. 

Family  history  negative.  Past  history  negative 
as  to  diseases  having  a  bearing  on  his  condition, 
with  the  exception  of  syphilis,  although  he  posi- 
tively denies  having  had  syphilis.  On  March  3 
a  positive  Wasserman  was  made,  which  probably 
is  the  etiological  factor  of  the  disease.  The  patient 
entered  this  hospital  with  a  large  pulsating,  ex- 
pansive tumor  in  and  above  the  episternal  notch. 

The  treatment  was  about  as  follows:  He  was 
at  once  put  to  bed  and  kept  quiet  for  a  few  days ; 
then  an  operation  was  performed  by  Professor 
Winslow.  He  was  brought  into  the  operating- 
room,  the  field  of  operation  having  been  pre- 
pared for  an  aseptic  operation  while  in  the  ward 
by  painting  the  skin  with  equal  parts  of  alcohol 
and  tincture  iodine.  No  anesthetic  was  used.  A 
fine  trocar  was  introduced  into  the  sac  and  a 
silver  wire  was  passed  through  this  trocar  into 
the  cavity.  Owing  to  the  difficulty  of  passing  the 
wire,  only  six  feet  were  introduced,  and  with  the 
needle  still  in  the  sac  the  galvanic  current  was 


126 


THE    HOSPITAL    BULLETIN 


connected  with  the  wire  for  ten  minutes  with  a 
current  of  twenty  milliampheres.  The  greater 
part  of  the  wire  curled  up  on  the  right  side,  and 
soon  it  was  noticed  that  this  side  was  firmer  to 
touch  than  the  left.  Six  days  later  another  opera- 
tion was  performed  similar  to  the  first,  with  the 
exception  that  two  pieces  were  used,  the  former 
sixteen  feet  long,  the  latter  only  four  feet,  and  a 
current  of  40  milliampheres  was  passed  for  20 
minutes  through  both  separate  pieces.  Subse- 
quently about  15  feet  of  wire  was  introduced, 
making  about  40  feet  altogether. 


i'n:.  1.   case  1. 
Aneurism  of  arch  of  aorta.— Dr.  R.  Winslow. 

This  operation  gave  the  patient  very  little  pain 
and  was  a  great  success,  for  instead  of  the  pul- 
sating expansive  tumor  we  now  had  a  tumor  with 
very  slight  pulsations ;  and  it  is  firm  to  touch, 
whereas  before  the  operation  it  was  very  thin 
and  soft  and  threatened  to  rupture.  This  treat- 
ment undoubtedly  prolonged  this  patient's  life, 
but  he  died  in  about  three  months  of  hemorrhage. 

Case  II.  On  January  2,  1912,  Lillian  Halla- 
way,  age  38,  entered  the  University  Hospital, 
complaining  of  a  swelling  in  median  line  of  the 
chest.  She  first  noticed  this  swelling  about  two 
years  previous  to  entrance,  but  had  pains  in  the 


FIG.    II.    CASE    I. 
Skiagram   of  aneurism  of  arch  of  the  aorta,   showing  about 
40  feet  of  silver  wire.— Dr.  H.  Winslow. 

chest  six  months  before  she  first  noticed  the 
swelling.  Physical  examination  shows  a  tre- 
mendous pulsating  tumor  of  upper  thorax,  ex- 
tending into  neck.  The  pulsations  are  in  all  di- 
rections and  (synchronously)  with  the  heart  beat. 
The  manubrium  and  the  five  upper  ribs  near  their 
costo-sternal  margin  are  entirely  eroded.  The 
tumor  extends  up  into  the  neck  and  has  two 
marked  projections,  ear-like  at  the  apex,  marked 
pulsations  over  entire  mass.  Expansile  walls  are 
very  thin. 

Patient  emaciated  and  unable  to  speak  above 
a  whisper,  breathing  labored. 

Family  History:  Mother  and  father  living  and 
well ;  two  sisters  and  five  brothers  all  living  and 
well.  No  history  of  rheumatism,  tuberculosis, 
malignancy ;  no  history  of  nervous  trouble.  Had 
two  children  born  dead.  No  live  children.  No 
other  history  of  lues. 

Past  History:  Had  whooping-cough  when 
quite  young.  Negative  to  measles,  mumps,  diph- 
theria, scarlet  fever  and  all  -other  diseases  of 
childhood.  Negative  to  typhoid  fever  and  pneu- 
monia ;  had  an  attack  of  malaria  several  years 
ago,  from  which  she  fully  recovered.  Venereal 
history  negative  as  regards  gonorrhea.  No  sore 
throat,  eruptions  over  body  or  hair  falling  out. 
No  history  of  lues  at  all. 


THE    HOSPITAL    BULLETIN 


127 


FIG.    III.    CASE    II. 

Aneurism   of  arch  of  aorta  protruding  through  chest  wall.— 

Dr.  R.  Winslow. 

Habits:  Has  not  slept  well  for  past  several 
years.  Drank  beer  moderately  until  about  a  year 
ago.  Drinks  one  or  two  cups  of  coffee  once  a 
day ;  uses  a  great  deal  of  snuff.  Drinks  five  or 
six  cups  of  tea  a  day. 

Menstrual  History:  Her  menses  appeared  at 
the  age  of  13;  occur  irregularly  and  last  from 
four  to  ten  days,  with  great  pain.  She  saw  her 
last  period  last  September.  The  flow  has  always 
been  very  profuse  at  time  of  menstruation.  She 
savs  that  just  before  the  period  began  there  was 
a  small  "pimple"  or  "pustule"  on  lahia,  which 
suppurated  and  disappeared  with  period.  These 
were  noticed  only  during  the  last  four  or  five 
years  of  her  menstrual  life,  but  did  not  appear 
every  month.     No  abortions  or  miscarriages. 

Present  Illness:  Last  April  she  noticed  a  slight 
bulging  in  chest  at  about  the  middle  of  sternum, 
which  gradually  grew  larger,  extending  upward. 

There  has  been  constant  pain  since  about  four 
months  before  she  noticed  the  swelling.  This 
pain  is  of  a  dull,  stinging  character  over  entire 
front  and  upper  part  of  chest.  She  says  that  at 
every  throb  of  her  heart  the  pain  is  more  intense. 

There  is  considerable  difficulty  in  speaking, 
and  great  pain  when  she  speaks.  There  is  also 
pain  on  swallowing;  sometimes  causes  violent 
coughing  spells. 


Alimentary  Tract:  She  has  suffered  for  several 
years  with  vomiting  spells.  Says  she  doesn't  re- 
member the  time,  if  before  or  after  meals.  The 
vomitus  was  of  a  greenish  color  and  bitter  taste. 
Says  there  was  occasionally  a  trace  of  blood  in 
the  vomitus.  Appetite  has  always  been  good. 
She  says  she  often  has  indigestion.  The  pains  are 
in  the  epigastric  region.  No  great  loss  of  weight. 
Says  she  would  lose  a  few  pounds,  but  would 
soon  gain  them  back.  Very  often  suffers  from 
diarrheal  attack  in  summer;  has  noticed  some 
blood  in  stools. 

Pulmonary  Tract:  No  history  of  cough  before 
the  present  illness.  No  bronchitis.  Some  hoarse- 
ness at  present.     No  spitting  of  blood. 

Cardie  Vascular  System:  Some  swelling  of 
ankles  before  the  present  illness,  which  was 
transient.  Negative  to  dyspnea,  palpitation  and 
all  other  symptoms  connected  with  this  tract,  ex- 
cept the  severe  pains  over  the  heart  during  the 
present  illness. 

Nervous  System:  When  patient  was  16  years 
of  age  she  began  suffering  with  epileptic  fits, 
which  occurred  about  two  or  three  times  a  month 
until  eight  years  ago,  at  which  time  she  came 
here  for  treatment  and  was  apparently  cured.  At 
the  time  of  these  "spells"  she  would  become  un- 
conscious and  fall  immediately  where  she  was  at 
that  time.  The  unconsciousness  usually  lasted 
about  one  hour.  She  says  that  two  or  three  days 
before  the  attack  she  could  tell  they  were  com- 
ing on. 

Notwithstanding  the  fact  that  she  has  a  nega- 
tive history  to  lues,  she  gave  a  positive  Wasser- 
man  reaction.  The  X-Ray  shows  a  large  tumor 
mass  filling  upper  chest,  extending  from  heart 
into  the  neck.  Erosion  of  the  sternum  and  ribs 
and  spinal  vertebrae  posteriorly  to  the  tumor. 

January  15,  1912,  patient  brought  to  the  oper- 
ating-room and  the  field  of  operation  prepared 
for  an  aseptic  operation  by  painting  the  surface 
with  dilute  tincture  iodine;  then  a  needle  was 
introduced  into  the  pulsating  tumor  and  36  feet 
of  fine  silver  wire  was  introduced  through  the 
needle.  The  needle  was  then  withdrawn  and  the 
wound  closed  with  a  collodion  dressing.  The 
patient  was  then  removed  to  her  bed  in  the  ward, 
no  worse  off  as  a  result  of  the  operation. 

Patient's  breathing  gradually  got  more  labored, 
and  on  January  18  she  died  without  any  rupture 
of  the  aneurism  having-  occurred. 


128 


THE    HOSPITAL    BULLETIN 


GASTRIC  ULCER. 


By  Nathan  Win.--i.oWj  M.D 


During  the  past  decade  indurated  ulcer  of  the 
stomach  has  passed  from  the  domain  of  medicine 
into  that  of  surgery.  This  has  been  brought  about 
chiefly  by  the  accidents  secondary  to  ulcer ;  com- 
plications which  are  in  themselves  necessarily  sur- 
gical. The  investigations  of  the  Mayos  have 
definitely  proven  at  least  60  per  cent,  of  gastric 
cancer  engrafted  on  an  old  ulcer  base.  As  the 
large  majority  of  ulcers  of  the  stomach  involve 
the  lesser  curvature  immediately  above  the 
pylorus,  the  thickening  resulting  from  the  chronic 
inflammatory  process  may  cause  obstruction  to 
the  free  passage  of  food  into  the  intestines.  The 
ulcerative  area  may  extend  through  the  entire 
thickness  of  stomach  wall  and  set  up  either  an 
acute  localized  or  generalized  peritonitis.  Follow- 
ing the  erosion  of  a  vessel  serious  hemorrhage  un- 
controllable by  medical  means  may  endanger  life. 
The  last,  but  not  the  least  important  factor  in 
compelling  the  shifting  from  the  internist  to  the 
surgeon,  was  the  realization  that  medicines  do  not 
give  permanent  relief.  Therefore  gastric  ulcer 
as  soon  as  recognized,  and  when  the  patient  is  in 
prime  physical  shape,  should  in  every  instance  be 
referred  bv  the  doctor  to  the  surgeon,  else  sooner 
or  later  some  one  of  the  above  mishaps  may 
ensue.  To  assure  the  patient  the  best  prospects 
of  cure  and  the  return  of  health  as  in  other 
surgical  affections,  the  malady  should  be  recog- 
nized earlier. 

Heretofore,  the  lack  of  prompt  recognition  has 
accounted  for  the  poor  operative  results,  but  to- 
day with  a  definite  clinical  picture  there  is  no 
reason  why  these  sufferers  should  not  be  brought 
to  operation  before  the  last  stages  of  starvation, 
and  thus  be  saved  not  only  years  of  suffering,  but, 
also,  the  possibility  of  death  from  cancer.  The 
only  case  upon  which  I  have  been  privileged  to 
operate  occurred  in  the  service  of  Dr.  Randolph 
Winslow  at  the  University  Hospital.  The  patient, 
a  woman,  with  perforating  ulcer  of  the  stomach 
and  peritonitis,  died. 

With  this  object-lesson  before  me;  I  desire  to 
impress  upon  my  readers  the  urgency  of  thor- 
oughlv  acquainting  themselves  with  the  mani- 
festations of  ulcer  of  the  stomach. 

Ulcer  of  the  stomach  may  be  classified  as  in- 
durated and  non-indurated  or  mucous,  or  surgical 


and  non-surgical.  The  non-surgical  ulcer  gives 
rise  to  no  definite  symptomatology.  It  occurs  as 
an  erosion  of  the  mucous  membrane,  from  which 
blood  seeps,  and  is  practically  impossible  of  de- 
tection, even  after  the  stomach  is  opened.  It  is 
the  indurated  ulcer  with  which  surgery  is  con- 
cerned, and  as  to  all  intents  and  purposes  the  por- 
tion of  the  duodenum,  which  is  above  the  bile 
duct  opening,  is  physiologically  a  portion  of  the 
stomach ;  what  is  said  concerning  ulcer  of  the 
stomach  applies  equally  as  well  to  duodenal  ulcer. 
The  first  portion  of  the  duodenum,  at  least  that 
part  above  the  common  bile  duct  is  developed 
from  the  foregut,  and  like  the  stomach  is  con- 
cerned with  the  preparation  of  food  for  digestion 
and  takes  no  part  in  absorption.  Indurated  ulcer 
is  essentially  chronic,  and  involves  not  only  the 
mucous  membrane,  but  also  some  or  all  of  the  un- 
derlying tissues.  In  the  stomach  proper  it  occurs 
with  about  equal  frequency  in  man  and  woman, 
but  in  the  duodenum  in  the  ratio  of  three  in  man 
to  one  in  woman.  It  is  generally  solitary,  but 
may  be  multiple.  By  far  the  majority  are  situated 
in  or  near  the  pylorus.  Heretofore  hyperchlor- 
hydria  has  been  insisted  upon  as  a  necessarv  ac- 
companiment of  ulcer.  Later  investigators,  how- 
ever, have  determined  that  too  much  dependance 
cannot  be  placed  upon  the  outcome  of  stomach 
analysis,  as  an  ulcer  is  frequently  present  when 
there  is  an  hypochlorhydria.  Thus  as  in  many 
other  maladies  experience  teaches  us  to  place 
more  weight  upon  the  existing  clinical  signs, 
rather  than  upon  the  results  of  the  laboratory ; 
not  that  the  laboratory  findings  are  not  of  value, 
which  would  be  a  mistake,  but  more  as  a  con- 
firmatory than  as  a  negative  aid.  The  svmpto- 
matology  of  ulcer  of  the  stomach  is  characteris- 
tic. The  patients  complain  of  gastric  disturbances 
which  have  extended  over  a  period  of  many  vears. 
The  periodicity  of  attacks  of  pain,  coming  on 
some  three  or  four  hours  after  meals,  sour  eructa- 
tions, belching  of  gas,  vomiting  and  hematemesis 
are  typical.  The  pain  is  at  its  worst  during  the 
height  of  digestion,  in  order  to  alleviate  which 
the  patient  soon  learns  to  take  more  food,  a  glass 
of  milk,  or  resorts  to  bicarbonate  of  soda  or  other 
mild  alkalies,  or  induces  vomiting'.  The  pain, 
however,  may  occur  on  an  emptv  stomach,  and 
especially  at  night,  as  a  consequence  of  which  the 
patient  places  food  near  the  bed  to  use  as  needed. 
In  the  beginning  the  patient  eats  large  quantities 
of  food,  but  as  the  disease  progresses  he  obtains 


THE    HOSPITAL    BULLETIN 


129 


more  relief  by  munching  more  frequently  smaller 
quantities.  During  the  later  stages  there  may  be 
almost  complete  loss  of  appetite.  Although  pain 
is  one  of  the  most  prominent  symptoms,  it  must 
be  distinctly  borne  in  mind  that  it  is  not  always 
present.  Much  emphasis  was  formerly  placed 
upon  the  reference  of  pain  to  the  left  subscapular 
region,  but  this  is  not  a  reliable  symptom.  When 
present  it  is  usually  seated  in  the  epigastrium,  for 
ulcer  of  the  stomach  to  the  left,  and  of  the  duode- 
num to  the  right  of  the  mid  line.  Vomiting  may 
not  exist  until  stenosis  of  the  pylorus  occurs,  but 
there  is  always  some  gastric  distress  and  eructa- 
tion of  sour,  bitter,  acrid,  fluid  or  belching  of 
sour  gas.  Great  stress  was  formerly  laid  upon 
hematemesis,  but  this  symptom  may  never  occur, 
as  the  ulcer  base  is  not  covered  with  a  granulation 
tissue,  but  is  smooth  and  of  a  grayish  color.  Ero- 
sion of  the  teeth  as  a  result  of  the  action  of  the 
acid  vomitus  is  not  uncommon.  Initially  the  nu- 
trition is  good,  but  as  the  disease  progresses  ow- 
ing to  the  ingestion  of  insufficient  quantities  of 
food  or  retention  in  the  stomach  due  to  thicken- 
ing of  the  pylorus,  emaciation  and  even  cachexia 
ensue.  Constipation  is  a  constant  concomitant. 
In  a  few  instances  a  tumor  may  be  felt.  If  the 
ulcer  be  seated  in  the  pyloric  region,  obstructive 
symptoms,  through  the  deposit  of  inflammatory 
products,  will  arise,  as  a  result  of  which  there  will 
be  dilatation  of  the  stomach  and  retention  of  food. 
The  index  of  retention  is  the  recovery  of  food 
eaten  six  or  seven  hours  previously.  Such  an 
attack  may  last  for  days  or  weeks,  to  be  followed 
by  a  period  of  relief,  and  sooner  or  later  a  re- 
mission. In  the  beginning  the  intermission  be- 
tween the  attacks  may  be  of  some  duration,  but 
as  the  disease  progresses  the  interval  between  is 
shorter,  and  the  attack  itself  more  prolonged. 

A  history  of  prolonged  gastric  disturbances  and 
discomfort,  pain  arising  four  or  five  hours  after 
meals,  and  relieved  by  the  ingestion  of  food, 
bicarbonate  of  soda,  milk,  etc.,  periodicity  of  at- 
tacks after  apparent  cure,  eructation  of  sour, 
acrid,  bitter  liquids,  munching  of  food  after  re- 
tiring at  night,  recovery  of  blood  from  stomach 
contents  with  a  high  hydrochloric  index  is 
pathogmonic  of  ulcer  of  the  stomach. 

The  question  of  treatment  in  gastric  ulcer  is 
intimately  tied  up  with  its  complications.  In  per- 
forating ulcer  the  opening  may  be  closed  by 
suture  and  drainage  instituted.  This  is  the  sim- 
plest line  of  action  and  is  especially  applicable  to 


patients  in  bad  condition.  I  followed  this  method 
in  the  above  mentioned  case. 

If  the  patient's  condition  warrants  the  ulcer 
bearing  area  may  be  excised,  or  either  of  the 
above  operations  may  be  combined  with  gastro- 
enterostomy by  the  no-loop  method.  Gastro- 
enterostomy by  itself  ofttimes  fails,  and  will  in- 
evitably do  so  unless  there  is  pyloric  obstruction. 
It  has  been  proven  when  the  pylorus  is  patent 
food  instead  of  passing  through  the  stomach- 
bowel  opening  will  preferably  follow  the  natural 
course.  If  the  ulcer  be  situated  in  or  near  the 
pylorus  and  obstructs  the  passage  of  food  gastro- 
enterostomy, when  performed  by  the  posterior 
no-loop  method,  gives  excellent  results.  This  is 
done  preferably  by  suture.  Owing,  however,  to 
the  possibility  of  the  development  of  cancer  on 
the  ulcer  base  some  operators,  and  especially  Rod- 
man, practice  and  advise  pylorectomy  with  gastro- 
enterostomy at  place  other  than  resection.  Ulcers 
of  the  body  and  the  lesser  curvature  should,  if 
practical,  be  excised.  Ulcer  of  the  duodenum  has 
not  the  same  tendency  to  undergo  malignant  de- 
generation as  ulcer  of  the  stomach ;  therefore, 
there  is  not  the  urgent  necessity  of  excision  as  in 
gastric  ulcer.  Here  gastroenterostomy  is  the 
usual  line  of  procedure,  but  if  the  indications  war- 
rant the  ulcer  may  be  excised. 

Mayo,  in  a  series  of  18  acute  perforations  oper- 
ated by  suture  alone,  and  states  that  only  one  re- 
quired a  secondary  gastrojejunostomy,  the  per- 
foration having  seemingly  put  an  end  to  the 
disease.  Acting  upon  the  observation  he  has 
twice,  in  chronic  gastric  ulcers  where  the  condi- 
tions were  such  that  he  could  not  excise  and 
where  gastroenterostomy  was  not  indicated,  ex- 
posed the  crater  of  the  ulcer,  thus  producing  the 
picture  of  an  acute  perforation,  then  closed  the 
defect  with  a  favorable  outcome.  In  the  early 
days  of  ulcer  surgery  pyloroplasty  was  a  favorite 
method  of  overcoming  the  obstruction,  but  was 
followed  by  so  many  relapses  requiring  secondary 
operations  that  it  has  been  to  a  large  extent  aban- 
doned. The  operative  technic  of  gastric  and 
duodenal  ulcer  has  reached  such  a  point  that  the 
mortality  is  neglible  and  may  be  summed  up  as 
follows:  Ulcers  to  theileft  of  the  pylorus  are 
excised  ;  in  the  pylorus  either  a  pylorectomy  or 
no-loop  gastroenterostomy  is  chosen  ;  in  case  of 
perforation  the  opening  may  be  sutured  or  better 
the  involved  area  excised — abdominal  drainage 
being  instituted,  no  matter  which  is  employed ; 


130 


THE   HOSPITAL   BULLETIN 


gastro-jejnnostomy    answers   well    for   duodenal 
ulceration. 

In  conclusion,  I  desire  to  emphasize  the  im- 
portance of  early  exploratory  operation  in  stom- 
ach affections,  producing  invalidism.  There 
should  be  no  conflict  between  medicine  and  sur- 
gery in  this  field.  If  after  a  reasonable  length  of 
medical  treatment  the  symptoms  remain  unabated, 
surgery  should  be  called  in  as  a  diagnostic  and 
possibly  therapeutic  measure. 


DROP  FINGER,  WITH  REPORT  OF  CASE. 


By  Nathan  Winslow,  M.D.,  Baltimore,  Md. 


The  finger  is  heir  to  many  injuries,  some  of 
which  are  common,  others  less  frequently  seen. 
Amongst  the  rarer  injuries  is  the  condition  known 
as  drop  or  mallet  finger.  Not  having  seen  such  a 
condition  until  recently,  the  writer  believed  it  of 
sufficient  interest  to  bring  to  the  attention  of  the 
readers  of  The  Bulletin,  so  that  when  dealing 
with  finger  injuries  they  may  bear  in  mind  its  pos- 
sibility. As  the  name  implies,  there  is  a  dropping 
of  the  terminal  phalanx  of  the  finger,  as  a  result 
of  either  complete  or  partial  rupture  of  the  ex- 
tensor tendon  near  its  insertion,  following  a  blow 
to  the  tip  of  the  extended  finger  causing  forcible 
flexion.  The  deformity  may  be  merely  a  slight 
dropping  or  the  bending  may  be  as  much  as  a 
right  angle. 

In  recent  cases  the  finger  should  be  extended 
and  a  splint  applied  after  thoroughly  padding  the 
parts.  The  splint  should  include  not  only  the 
finger,  but  also  the  wrist  of  the  affected  hand,  so 
as  to  thoroughly  relax  the  tendon  and  thus  favor 
union.  If  this  procedure  proves  ineffectual,  the 
tendon  should  be  exposed  by  an  incision,  and  the 
torn  end  sutured  into  the  periosteum  of  the  base 
of  the  terminal  phalanx  ;  and  the  finger  and  wrist 
immobilized  as  recommended  above. 

CASE. 

Mrs.  M.  consulted  me  during  the  early  part  of 
November  (iqii)  about  an  injury  she  had  sus- 
tained to  the  middle  finger  of  her  right  hand 
which  she  had  incurred  by  striking  the  tip  against 
a  board  a  few  weeks  previously.  The  blow  was 
so  severe  that  the  finger  felt  numb,  and  on  ex- 
amination she  noticed  the  end  phalanx  flexed  and 


voluntary  extension  impossible.  She  was  able, 
however,  to  straighten  the  finger  with  the  aid  of 
her  other  hand,  but  the  deformity  recurred  as 
soon  as  the  support  was  released.  When  I  saw 
the  patient  the  deformity  was  typical  of  the  con- 
dition, and  the  diagnosis  readily  made  upon  the 
receipt  of  the  history  of  the  accident.  Splintage 
in  extension  was  ordered,  and  immobilization  was 
maintained  for  six  weeks.  Though  the  finger  is 
still  somewhat  swollen  and  at  times  painful,  it  is 
functionally  perfect,  voluntary  extension  and 
flexion  being'  almost  normal. 


The  following  have  received  appointments  as 
clinical  assistants  at  the  LJniversity  Hospital  for 
1912-1913: 

S.  A.  Alexander,  North  Carolina. 
John  T.  Beavers,  North  Carolina. 
B.  Karl  Blalock,  North  Carolina. 
Earle  G.  Breeding,  Maryland. 
J.  M.  Buch,  Cuba. 
Humphrey  Butler,  Maryland. 
Leo  M.  Cavanaugh,  Maryland. 
Vernon  H.  Condon,  Maryland. 
Frederick  L.  Detrick,  Virginia. 
Idalberto  Fajardo,  Cuba. 
Leonard  Hays,  Maryland. 
Ploward  E.  Lecates,  Maryland. 
Elmer  Newcomer,  Maryland. 
Norbert  C.  Nitsche,  Maryland. 
Walter  A.  Ostendorf,  Mar  viand. 
Harry  C.  Raysor,  South  Carolina. 
William  Henry  Scruggs,  Jr.,  Georgia. 
Hamilton  J.  Slusher,  Virginia. 
W.  Houston  Toulson,  Maryland. 
Moody  R.  Troxler,  North  Carolina. 
Grady  1!.  Wells,  South  Carolina. 
Cleveland  D.  Whelchel,  Georgia. 
Thomson  B.  Woods,  South  Carolina. 


Among  the  University  alumni  practicing  in 
Maine  are: 

Hebron — Ralph  Norvel  Knowles,  class  of  1909. 

Lewiston — Jos.  Wm.  Scannell,  class  of  1906, 
471  Main  street. 

Machias — Harry  Otis  Johnson,  class  of  1903. 

Rumford — Louis  M.  Pastor,  class  of  1906. 

Washburn — Fay  Frederick  Larrabee,  class  of 
1906. 

Winterport — Wm.  A.  Ellingwood,  class  of 
1908. 


THE    HOSPITAL    BULLETIN 


131 


THE   HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Meficine  and  Surgery 

PUBLISHED  BY 

THE  HOSPITAL  BULLETIN  COMPANY 

608  Professional  Building 

Baltimore,  Mu. 


Subscription  price,     .     .     .     $1.00  per  annum  in  advance 

Reprints  furnished   at  cost.     Advertising  rates 
submitted  upon  request 


Nathan  Winslow,  M.D.,  Editor 


Baltimore,  September  15,  1912. 


PROF.  JULIAN   J.   CHISOLM   AND   MISS 
HELEN  KELLER. 


It  will  be  a  source  of  gratification,  as  well  per- 
haps as  a  great  surprise,  to  learn  that  Professor 
Chisolm  was  connected  in  any  way  with  the  won- 
derful case  of  Helen  Keller,  or  to  put  it  more 
correctly,  the  case  of  the  wonderful  Helen  Keller. 
Blind,  deaf  and  dumb,  without  the  light  of  the 
dav  and  almost  without  that  of  the  mind,  she  has 
become  one  of  the  most  highly  educated  woman 
in  the  world.  She  can  speak  not  only  English 
fluently,  but  French  and  German  also;  she  can 
read  Latin  and  Greek  and  is  conversant  with 
many  other  branches  of  learning.  In  an  address 
before  the  Congress  of  Otiologists,  held  in  Bos- 
ton recently,  she  gives  Dr.  Chisolm  the  credit  for 
advice  that  led  to  her  restoration  to  society  as  a 
useful  and  highly  intelligent  integer.  It  gives  us 
pleasure  to  reproduce  the  following  extract  from 
the  Baltimore  Sun: 

Chisolm  and  Helen  Keller 


Baltimore  Specialist   Suggested  Her  Education. 

[From  the  speech  by  1  ielen  Keller  to  the  1  Hiolo- 
gists'  Congress  in  Boston.] 

"I  was  about  six  years  old  before  any  of  the 
specialists  whom  my  parents  consulted  was  brave 
enough  to  tell  them  that  I  should  never  see  or 
hear.  It  was  Dr.  Chisolm  of  Baltimore  who  told 
them  my  true  condition.  'But,'  said  he.  She  can 
be  educated,'  and  he  advised  my  father  to  take 


me  to  Washington  and  consult  Dr.  Alexander 
( Iraham  Bell  as  to  the  best  method  of  having  me 
taught. 

"Dr.  Chisolm  did  exactly  the  right  thing.  My 
father  followed  his  advice  at  once,  and  within  a 
month  I  had  a  teacher,  and  my  education  was 
begun.  From  that  intelligent  doctor's  office  I 
passed  from  darkness  to  light,  from  isolation  to 
friendship,  companionship,  knowledge.  The  par- 
ent wdio  brings  his  child  to  your  office,  to  your 
hospitals,  should  find  in  you,  not  a  teacher,  per- 
haps, but  one  who  understands  how  far  it  is  pos- 
sible to  right  the  disaster  of  deafness." 

Dr.  Chisolm  was  not  only  a  great  ornament  to 
the  University  of  Maryland,  and  a  teacher  of 
great  force  and  erudition,  but  he  was  also  a  very 
prominent  citizen.  He  retired  from  teaching  in 
1894  and  died  in  1903. 


O  >MBINING    THE    MEDICAL    SCFIOOLS 
I  IF  BALTIMORE. 


Medical  education  in  this  country  is  in  a  state 
of  rapid  evolution,  and  is  at  this  time  in  a  transi- 
tional condition.  On  the  one  hand  we  have  some 
of  the  State  universities  and  the  highly  endowed 
private  schools,  demanding  qualifications  that  are 
almost  impossible  of  attainment.  On  the  other 
hand  there  are  many  schools  of  very  low  grade 
that  bring  disrepute  on  the  medical  profession. 
There  are  also  other  institutions  that  do  not  main- 
tain the  most  advanced  standards,  that  are  never- 
theless doing  as  useful  work  as  the  first  men-  • 
tioned  class,  but  of  a  somewhat  different  charac- 
ter. If  an  institution  is  so  well  endowed  that  it 
can  demand  that  all  candidates  for  admission 
shall  have  academic  degrees,  it  is  its  right  to  do 
so,  and  it  ensures  a  highly  desirable  class  of  stu- 
dents. It  does  not  seem  proper,  however,  that  the 
profession  of  medicine  shall  be  an  aristocracy 
rather  than  a  democracy,  and  there  must  be 
schools  where  those  whose  circumstances  of  one 
kind  or  another  have  prevented  their  obtaining  a 
college  education,  may  nevertheless  secure  a  medi- 
cal training. 

It  is  a  question  as  to  the  desirability  and  pro- 
priety of  exacting  such  high  standards,  and  cer- 
tainly at  this  time  but  few  colleges  can  do  so. 
The  Baltimore  medical  schools  belong  to  this 
middle  class,  that  give  excellent  training  in  medi- 
cine, but  only  require  a  completed  four  years 
high    school   course    for   admission.     There   are 


132 


THE   HOSPITAL    BULLETIN 


too  many  medical  colleges  in  this  country,  and  an 
effort  is  being  made  to  reduce  the  number  and  to 
improve  those  that  remain.  The  suggestion  has 
come  from  many  sources,  to  merge  the  three 
larger  schools  here,  and  to  form  one  school,  bet- 
ter equipped  and  better  financed  than  the  three 
separate  schools. 

It  is  with  pleasure  that  we  notice  an  interest  in 
this  matter  aroused  in  this  city,  as  the  following 
editorial  from  the  Baltimore  Sun  of  August  28, 
1912,  indicates: 

COMBINING  THE    MEDICAL  SCHOOLS. 

"If  the  University  of  Maryland,  the  College  of 
Physicians  and  Surgeons  and  the  Baltimore 
Medical  College  can  be  consolidated,  and  the  com- 
bined endowment  funds  used  to  create  a  medical 
school  of  the  very  highest  rank,  it  would  be  a  de- 
sirable thing. 

"Doubtless  there  would  be  many  incidental  diffi- 
culties in  the  way,  but  the  men  capable  of  guid- 
ing a  great  medical  school  ought  to  be  capable  of 
surmounting  these  difficulties. 

"Of  course,  any  consolidation  of  the  kind  must 
retain  the  historic  and  honored  name  of  the  Uni- 
versity of  Maryland,  an  institution  which  has 
done  so  well  with  the  comparatively  meager  funds 
it  has  had  at  its  disposal  as  to  give  assurance  of 
yet  better  service  if  it  should  ever  become  pos- 
sessed of  an  ample  purse." 

This  desirable  result  can  be  easily  accomplished 
if  the  citizens  of  this  city  will  come  to  the  aid  of 
the  medical  schools.  The  citizens  of  Baltimore 
have  been  very  liberal  to  another  university,  and 
we  now  appeal  to  them  to  help  us  to  form  and 
maintain  another  high-grade  medical  school  here. 


KEEP  A-PULLIX'. 


When  you've  got  a  thing  to  say.  say  it.  Some 
people  have  something  to  say,  others  make  a  lot 
of  noise,  but  say  nothing.  The  Universitv  of 
Maryland  is  passing  through  a  transition.  The 
opportunity  for  broader  efforts  is  within  her 
grasp.  At  no  time  in  her  history  has  she  been  in 
such  a  maelstrom  of  unrest.  Nobody  km  >ws 
what  tomorrow  will  bring  forth.  Surprises  are 
the  order  of  the  day.  Progress  is  the  rally  call. 
The  daily  papers  are  giving  us  kindly  notices  and 
arc  bringing  our  needs  to  the  attention  of  the 
public.  We  need  it  all:  but.  alumni,  we  need 
above  all  your  kindly  advice  and  sympathy.     As- 


sist us  by  your  counsel,  and  exert  whatever  influ- 
ence you  may  possess  with  the  several  faculties 
for  the  appointment  of  a  paid  head  of  the  institu- 
tion. The  Bulletin  desires  to  sound  your  senti- 
ment in  this  matter.  Its  pages  are  at  your  dis- 
posal. But  come  what  may — always  keep  a-pull- 
in'  for  a  better  day. 


THE  PATHOLOGICAL  ENDOWMENT 
FUND. 


The  chairman  of  the  endowment  committee 
has  been  away  on  a  vacation,  and  everybody  else 
has  been  away.  The  heat  and  humidity  have  been 
equal  to  that  of  the  Canal  Zone,  and  the  dog  days 
have  been  unusually  oppressive.  No  efforts  have 
been  put  forth  to  add  materially  to  the  pathological 
fund,  and  nobody  has  surprised  us  by  insisting  on 
giving  a  large  donation  to  the  fund.  We  cannot 
report,  therefore,  any  great  increase,  but  are 
thankful  for  the  little  that  has  occurred. 

CONTRIBUTION     BY    CLASSES. 

1S4S $50  00 

1864 20  OO 

1868 10  00 

1871 35  0CI 

1872 70  00 

1873 430  00 

1874 5  00 

1875 5  00 

1876 115  00 

1877 10  00 

1880 5  00 

1881 250  00 

1882 310  00 

1 883 40  00 

18S4 40  00 

1885 235  03 

1886 IOO  OO 

1888 50  OO 

1889 100  00 

1890 175  00 

1892 150  00 

1893 40  00 

1894 135  00 

1895 155  00 

1896 52  00 

1897 80  00 

1898 105  00 

[899 50  00 

1900 215  00 


THE    HOSPITAL    BULLETIN 


133 


1901 240  00 

1 902 305  00 

1903 315  °o 

1904 145  °° 

1905 210  00 

1  ( of  1 1 65  00 

1907 1 10  00 

1908 20  00 

i9°9 5  00 

1910 50  00 

I'M  1  Terra  Mariae 3  5° 

hm 2  Club  Latino  Americano 25  00 

Total  subscriptions  to  Sept.  1,  1912. £10,181  50 

NEW  SUBSCRIPTIONS   IN   AUGUST. 

Dr.  L.  W.  Talbott,  1883 $5  00 

Dr.  B.  F.  Bussey,  1884 40  od 

Total $45  00 


ITEMS 


Dr.  Charles  Wesley  Gardiner,  class  of  1901,  is 
located  at  449  State  street,  Bridgeport,  Conn. 


We  are  in  receipt  of  the  following  letter  from 
Dr.  Love,  and  are  glad  to  "pass  it  on"  to  our 
alumni : 

September  10,  1912. 
Nathan  Winslow,  M.D.: 

My  Dear  Doctor — In  reply  to  your  request  for 
the  treatment  of  tetanus  as  used  in  the  Frank- 
lin Square  Hospital,  will  state  that  for  the  past 
five  or  six  years  we  have  been  using  the  Bacilli 
method,  which  is  the  administrating  hypoder- 
mically  of  carbolic  acid.  I  generally  order  a  2 
per  cent,  solution  of  carbolic  acid  : 

R     Acid  carbolici       5 
Aq.  distillat      245 

Of  this  I  give  hvpodermically  30  m.  (1.84  c.c. ) 
containing  acid,  carbolic,  gr.  3/5  (.0387  gm.) 
every  three  hours,  and  gradually  increase  the 
dosage  or  shorten  the  interval  until  patient  gets 
from  grs.  viii  to  xv  (0.5  to  1.  gm.)  daily. 

There  is  no  selective  point  for  the  injection. 

With  this  as  curative  treatment  we  try  to  con- 
trol convulsions  with  chloral,  chloretone,  bro- 
mides or  morphia  in  suitable  doses.  During  the 
administration  of  carbolic  acid  the  urine  is  ex- 
amined daily. 

Enemas  of  normal  salt  solution  given  daily. 


There  have  been  nine  cases  of  tetanus  treated 
at  the  Franklin  Square  Hospital  during  the  past 
seven  years,  with  one  death,  and  this  case  re- 
ceived serum  treatment,  but  no  carbolic  acid. 
Three  cases  received  each  one  injection  of  serum 
and  the  Bacilli  treatment.  Five  cases  received 
the  carbolic  acid  treatment  only. 

I  believe  Dr.  P.  Kintzing  treated  the  larger 
number  of  these  cases  besides  several  other  cases 
in  his  private  practice.  Naturally  we  first  disin- 
fect the  wound.  Very  truly  yours, 

William  S.  Love, 

Class  of  1890. 


Dr.  Benjamin  Newhouse,  class  of  1912,  who 
was  for  a  time  resident  pathologist  at  the  lie- 
brew  Hospital,  is  now  resident  surgeon  in  the 
Emergency  Hospital.  Washington,  D.  C.  In  his 
examinations  before  the  State  Board  in  Maryland 
Dr.  Newhouse  received  100  in  surgery  and  97  in 
obstetrics. 


Dr.  Nathan  Winslow,  class  of  1901,  left  on  the 
nth  for  a  trip  to  St.  Augustine  and  Jackson- 
ville, Fla. 


Dr.  John  C.  Hemmeter,  in  the  Baltimore  Even- 
ing Sun  of  July  18,  has  the  following  to  say  con- 
cerning the  report  on  the  medical  schools  made  by 
Abraham  Flexner  to  the  Carnegie  Foundation  : 

"To  do  justice  to  the  past  and  present  state  of 
the  systems  of  medical  education  in  this  country, 
we  must  take  into  consideration  the  political  en- 
vironment under  which  they  were  created.  At  a 
period  in  the  history  of  our  people  when  the  State 
was  incapable  or  unwilling  to  provide  for  financial 
support  of  secondary  schools  and  universities, 
there  was  no  other  way  of  securing  the  institu- 
tions and  teachers  except  by  private  undertakings. 
Naturally,  this  method  of  organizing  medical 
schools  was  abused,  and  in  many  cities  these  so- 
called  colleges  were  started  for  egotistical  pur- 
poses, exclusively,  not  really  to  advance  either 
medical  discipline  or  science,  and  Dr.  Prichett  is 
right  in  condemning  such  schools.  He  and  Flex- 
ner may  be  pardoned  for  being  too  sweeping  in 
their  otherwise  laudable  and  correct  generaliza- 
tions. 

"To  understand  the  European  professional  edu- 
cation one  must  appreciate  what  Dr.  Pritchett 
and  Mr.  Flexner  admit,  namely,  that  it  is  based 
on  an  exceptionally  high  level  of  secondary  school 


134 


THE    HOSPITAL    BULLETIN 


discipline  in  Germany.  A  standard  of  this  kind 
has  not  yet  been  attained  in  America. 

"Dr.  Pritchett  states  that  a  system  of  education 
is  to  be  judged  not  by  its  occasional  brilliant  suc- 
cesses, but  by  the  general  level  of  performances 
of  those  whom  it  undertakes  to  train.  Exactly 
so,  and  judged  by  that  method  the  University  of 
Maryland  is  an  institution  of  learning  that  need 
not  be  ashamed  of  its  record,  for  among  its  alumni 
today  are  professors  in  our  largest  and  most 
richly  endowed  American  universities.  It  has 
produced  such  men  as  William  T.  Councilman, 
professor  of  pathology  at  Harvard  University : 
Homer  Wright,  professor  of  pathology,  Harvard 
Medical  School;  Alexander  C.  Abbott,  professor 
of  bacteriology,  University  of  Pennsylvania  ;  Wil- 
liam T.  Howard,  professor  of  pathology,  West- 
ern Reserve  University;  Major  James  Carroll, 
discoverer  of  the  transmission  of  yellow  fever 
by  the  bite  of  a  specific  mosquito. 

"In  addition  to  these  men,  I  might  mention  Gen. 
Rupert  Lee  Blue,  the  present  Supervising  Sur- 
geon-General of  the  United  States  Marine  Hospi- 
tal Service,  and  also  Dr.  Henry  R.  Carter,  who 
first  announced  and  discovered  the  so-called  ex- 
trinsic method  of  incubation  of  the  yellow  fever 
infective  agent. 

''When  an  institution  like  the  University  of 
Maryland  turns  out  so  many  original  discoverers 
and  brilliant  thinkers  this  could  not  possibly  be 
accidental,  as  Dr.  Pritchett  would  suggest  when 
he  states  that  'a  poor  school  may  from  time  to 
time  bring  forth  great  practitioners.'  In  the  same 
manner  some  are  inclined  to  assign  the  brilliant 
work  of  our  alumni  not  to  the  training  of  inspir- 
ing teachers  who  are  competent  masters  of  the 
subjects  they  teach  in  the  University  of  Mary- 
land, but  they  fictitiously  assign  their  brilliancy 
to  laboratories  and  other  universities  in  which 
some  of  our  alumni  took  short  post-graduate 
courses.  If  this  were  applied  to  the  very  univer- 
sities that  Dr.  Pritchett  lauds  in  this  manner, 
these  institutions  would  be  robbed  of  the  credit 
of  having  trained  and  developed  some  of  the  best 
minds  among  their  alumni.  For.  upon  investiga- 
tion, it  is  found  that  the  alumni  of  Harvard,  Yale 
and  Johns  Hopkins  have  taken  post-graduate 
courses  in  Germany,  Austria,  England  and 
France. 

"It  is  not  the  short  post-graduate  course,  which 
rarely  exceeds  one  year,  that  develops  the  great 
thinker  and   research   worker,  but   the  constant, 


enduring  guidance  of  the  professor  who  conducts 
his  pupil  for  several  years,  beginning  with  the 
very  first  instruction  he  ever  receives  in  medicine. 

"In  the  Johns  Hopkins  University  itself  the 
dean  of  the  Department  of  Medicine,  both  pro- 
fessors of  ophthalmology,  the  professor  of  psy- 
chiatry and  the  professor  of  neurology  are  alumni 
of  the  University  of  Maryland. 

"On  page  289  of  the  report  Dr.  Abraham  Flex- 
ner  gives  some  interesting  statistics  of  the  money 
spent  in  five  German  universities  for  professional 
salaries,  the  number  of  their  assistants,  the  cost 
thereof,  the  number  of  servants  and  the  laboratory 
expense.  I  can  judge  only  of  my  department  at 
the  University'  of  Maryland  and  can  say  that  the 
professor  of  physiology  receives  more  salary  at 
the  University  of  Maryland  than  is  devoted  to 
that  purpose  at  Berlin,  Leipzig,  Koingsberg, 
Griefswald  or  Giessen.  That  he  has  three  paid 
assistants,  which  number  is  exceeded  only  by  the 
University  of  Berlin,  and  that  our  laboratory  ex- 
penses are  greater  than  those  of  Konigsberg, 
( iriefswald  or  Giessen.  The  reason  why  Berlin 
and  Leipzig  spend  more  for  assistants  and  labora- 
tory expenses  than  the  LTniversity  of  Maryland 
does  is  due  to  the  fact  that  they  teach  four  times 
as  many  students. 

"The  entire  volume  written  by  Dr.  Flexuer  on 
Medical  Education  in  Europe  represents  the  most 
scholarly  and  comprehensive  contribution  to  this 
subject  ever  published  in  America." 


The  following  alumni  have  been  appointed  to 
positions  in  the  City  Health  Department : 

Health.  Warden,  Thirteenth  Ward,  Dr.  John 
Henry  Yon  Dreele,  class  of  1910,  succeeding  Dr. 
Vernon  F.  Kelly,  class  of  1904;  salary,  $900  per 
annum. 

Health  Warden,  Fourteenth  Ward,  Dr.  Edwin 
Kemp  Bartlett,  class  of  1887,  succeeding  Dr. 
William  Caspari :  salary,  $900. 

Dr.  Marshall  G.  Smith,  class  of  1887,  has  re- 
tired as  Health  Warden  of  the  Nineteenth  Ward. 


Dr.  Arthur  Dean  Bevan  of  Chicago,  a  director 
of  the  American  Medical  Association,  will  be  the 
guest  of  Prof.  Randolph  Winslow  during  the 
month  of  September,  and  will  take  an  active  in- 
terest in  the  proposed  merging  of  the  Baltimore 


THE    HOSPITAL    BULLETIN 


135 


Medical  College  and  the  College  of  Physicians 
and  Surgeons  with  the  University  of  Maryland. 


Dr.  John  J.  R.  Krozer,  class  of  184S,  and 
nestor  of  the  University  alumni  in  Baltimore, 
took  an  automobile  ride  for  the  first  time  in  his 
life  on  September  4.  Dr.  Krozer  rode  but  four 
squares,  and  it  took  some  persuasion  to  induce 
him  to  enter  the  car.  Dr.  John  C.  Harris,  class 
of  1862,  was  with  him.  Dr.  Krozer  is  85  years 
of  age,  and  says  he  prefers  a  horse  and  buggy 
any  day  to  the  machine. 


Dr.  Charles  A.  Hollingsworth,  class  of  1881, 
has  been  appointed  postmaster  of  Belair,  Md. 
Dr.  Hollingsworth  has  been  a  practicing  physician 
in  Belair  for  over  30  years.  He  is  55  years  of 
age.  lie  married  a  Miss  Young,  daughter  of  the 
late  Colonel  Young,  and  has  four  sons  and  a 
daughter.  He  received  notification  of  his  appoint- 
ment by  a  telephone  message  from  the  First  As- 
sistant Postmaster-General. 


Dr.  Thomas  Chew  Worthington,  class  of  1876, 
spent  the  summer  at  his  country  place  in  Balti- 
more county. 


Dr.  Eugene  Bascom  Wright,  class  of  1009, 
resident  physician  at  the  Church  Home  and  In- 
firmary since  September  2,  1911,  has  succeeded 
Dr.  Chadbourne  Andrews  as  resident  physician 
of  the  Hebrew  Hospital. 


Dr.  Walter  IT.  Mayhew,  class  of  1901,  is  an 
assistant  resident  physician  at  the  Maryland  Tu- 
berculosis Sanitarium,  at  State  Sanatorium,  Md. 


Dr.  William  J.  Coleman,  class  of  1908,  has  been 
reappointed  superintendent  of  the  University 
Hospital  for  the  coming  year. 


Dr.  Charles  A.  Waters,  class  of  inir,  is  on  the 
X-ray  staff  of  the  Johns  Hopkins  University.  Tt 
gives  us  pleasure  to  announce  to  his  friends  that 
he  is  making  good  in  his  chosen  line. 


The  residence  of  Dr.  August  Horn,  class  of 
[888,  40  E.  25th  street,  Baltimore,  suffered  slight 
damage  by  being  struck  by  lightning  during  a 
heavy  rainstorm  in  August.  The  chimney  was 
struck  and  a  number  of  bricks  thrown  into  the 
street.     The  current  then  ran  from  the  chimnev 


down  the  metal  cornice  of  the  adjoining  house 
in  the  form  of  a  ball  of  fire,  jumped  to  an  unused 
wire,  dropped  a  few  sparks  and  disappeared. 


The  following  University  alumni  are  members 
of  the  faculty  of  the  College  of  Physicians  and 
Surgeons,  Baltimore : 

Charles  F.  Bevan,  M.D.,  class  of  1871,  profes- 
sor of  principles  and  practice  of  surgery,  clinical 
and  genito-urinary  surgery. 

George  W.  Dobbin,  A.M.,  M.D.,  class  of  1894, 
professor  of  obstetrics  and  gynecology. 

William  Royal  Stokes,  M.D.,  Sc.D.,  class  of 
1891,  professor  of  pathology  and  bacteriology. 

Archibald  C.  Harrison,  M.D.,  Class  of  1887, 
professor  of  anatomy  and  clinical  surgery. 

Cary  B.  Gamble,  Jr.,  A.M.,  M.D.,  class  of  1887, 
professor  of  clinical  medicine. 

Charles  E.  Simon,  A.B.,  M.D.,  class  of  1890. 
professor  of  clinical  pathology  and  experimental 
medicine. 

Anton  G.  Rytina,  M.D.,  class  of  1905,  associate 
in  genito-uninary  surgery. 

Francis  W.  Janney,  M.D.,  class  of  1905,  asso- 
ciate in  ophthalmology  and  otology. 

William  T.  Watson,  M.D.,  class  of  1S91,  asso- 
ciate in  medicine. 

S.  Griffith  Davis,  M.D.,  class  of  1893,  lecturer 
on  anesthetics  and  assistant  demonstrator  of 
anatomy. 

W.  Milton  Lewis,  M.D.,  class  of  1888,  assistant 
in  clinical  laboratory. 

Joseph  L.  Kemler,  M.D.,  class  of  1907,  assist- 
ant in  ophthalmology  and  otology. 


Drs.  Archibald  C.  Harrison,  class  of  1887 ; 
George  W.  Dobbin,  class  of  1894;  Cary  B.  Gam- 
ble, class  of  1887;  William  T.  Watson,  class  of 
1891,  and  William  Royal  Stokes,  class  of  1891, 
are  on  the  visiting  staff  of  the  Mercy  Hospital. 


Dr.  George  W.  Dobbin,  class  of  1894,  is  one  of 
the  visiting  obstetricians  to  the  Maternite  Hos- 
pital of  the  Mercy  Hospital. 


Among  the  admitting  physicians  to  the  State 
Sanatorium  are  Drs.  Robert  S.  Page,  class  of 
1898,  Belair,  Md. ;  Guy  Steele,  class  of  1897, 
Cambridge,  Md.;  James  McFaddin  Dick,  class  of 
1895,  Salisbury,  Md. :  Louis  Bernard  Ilenkel,  Jr., 
class  of  1903,  Annapolis,  Md. ;  Henry  Maynadier 
Fitzhugh.  class  of  1807.  Westminster,  Md.,  and 


136 


THE    HOSPITAL    BULLETIN 


Guy  Walter  Latimer,  class  of  1901,  Hyattsville, 
Md.  Dr.  Guy  Steele  is  also  a  member  of  the 
board  of  directors. 


Dr.  William  B.  Fellers,  class  of  1910,  is  located 
at  12^2  Campbell  avenue  S.  W.,  Roanoke,  Va. 


Dr.  Benjamin  F.  Carpenter,  class  of  1899,  of 
Belton,  S.  C,  was  a  recent  visitor  to  the  Univer- 
sity Hospital. 


At  the  last  meeting  of  the  Alumni  Athletic  As- 
sociation it  was  decided  to  support  football,  base- 
ball and  basket-ball  during  the  coming  season. 
Drs.  Mitchell,  Todd  and  Bay  were  appointed  a 
committee  to  arrange  for  a  track  meet  in  the  early 
fall.  Dr.  R.  G.  Willse  has  consented  to  act  as 
coach  for  the  football  team  during  the  season. 


Dr.  Russell  Hardy  Dean,  Jr.,  class  of  1012,  is 
practicing  with  his  father  in  Jacksonville,  Fla. 
Their  office  is  located  at  Monroe  and  Cedar 
streets. 


The  six  full-time  teachers  in  the  University  of 
Maryland  for  the  season  of  1912-13  will  be  Drs. 
I.  M.  Macks  (pathology),  J.  Holmes  Smith 
(anatomy),  R.  Dorsey  Coale  (dean,  chemistry). 
T.  L.  Patterson  (physiology  and  biology),  H.  J. 
Maldies  (histology  and  embryology),  and  a  sixth 
to  be  appointed. 


The  following  alumni  are  members  of  the  dis- 
pensary staff  of  the  Mercy  Hospital :  W.  Milton 
Lewis,  M.D.,  class  of  1888  (skin  diseases)  ;  F.  W. 
Janney,  M.D,.  class  of  1905,  Joseph  I.  Kemler, 
M.D.,  class  of  1907  (diseases  of  eye  and  ear),  and 
Anton  George  Rytina,  class  of  1905  (genito- 
urinary surgery  ). 


The  staff  of  the  University  of  Maryland  Ma- 
ternity Hospital  for  1912-13  is  as  follows  : 

Prof.  L.  E.  Neale,  M.  D..  director,  class  of  1881. 

Drs.  L.  H.  Douglas,  class  of  1911;  John  D. 
Darby,  class  of  191 2,  and  William  Michel,  class 
01  [912,  resident  physicians. 


Among   the    University    alumni    practicing   in 
Georgia  are : 

Albany — John  Cox  Keaton,  class  of  1907. 
Atlanta — Edgar   G.   Ballenger,   class   of    1901, 


Atlanta  National  Bank  Building ;  William  Zellars 
Holliday,  class  of  1882,  The  Grand  Building; 
Herbert  Jerome  Rosenberg,  class  of  1908,  Grant 
Building. 

Baxley — P.  H.  Comas,  class  of  18S2. 

Brunswick — Julian  P.  Harrell,  class  of  1906, 
502Tj  Gloucester  street. 

Byronville — Edgar.B.  Watts,  class  of  1904. 

Cedartown — Wm.  Allen  Chapman,  class  of 
1887. 

Dalton — Harlan  L.  Erwin,  class  of  1904. 

Davisboro — Wm.  Benj.  Warthen,  class  of  1905. 

Donaldsonville — Nathaniel  L.  Spengler,  class 
of  1903. 

Douglas — Charles  Wesley  Roberts,  class  of 
1906. 

Dudley — Josiah  B.  Walker,  class  of  1S90. 

Fitzgerald — Edwin  J.  Dorminy,  class  of  1890. 

Gainesville — Henry  Latimer  Rudolph,  class  of 
1902. 

Graymont — Rufus  Cecil  Franklin,  class  of 
1907 ;  Virgil  E.  Franklin,  class  of  1896. 

Harrison — Elijah  S.  Peacock,  class  of  1891. 

La  Grange — U.  R.  Allen,  class  of  1882,  R.  F. 
D.  No.  5. 

Louisville — Samuel  T.  R.  Revell,  class  of  1905  ; 
Jefferson  D.  Wright,  class  of  1882. 

Macon — Thomas  E.  Clackshear,  class  of  1S04, 
Grand  Building ;  Jos.  W.  De  Guid,  class  of  1893, 
5725-2  Cherry  street ;  Weems  R.  Winchester,  class 
of  1874,  610  Mulberry  street. 

Manchester — Herbert  Melvin  Foster,  class  of 
1910. 

Marietta— J.  D.  Malone,  class  of  1884. 

Mt.  Vernon — Charles  Hicks,  class  of  1877. 

Osierfield — Redding  Hamilton  Pate,  class  of 
1898. 

Quitman — Samuel  S.  Gaulden,  class  of  1886. 

Reidsville — Orlando    L.    Alexander,    class    of 

1875- 

Rochelle — J.  A.  Bussell,  class  of  18S8;  Charles 
D.  McRae,  class  of  1888. 

Sandersville — George  Skinner  McCarty,  class 
of  1905  ;  William  Rawlings,  class  of  1875;  Oscar 
L.  Rogers,  class  of  1897. 

Savannah — Craig  Barrow,  class  of  1900,  26 
Liberty  street.  East ;  Julian  Ford  Chisohm,  class 
of  1000,  6  E.  Liberty  street;  Benjamin  Harrison 
Gibson,  class  of  1909,  14  W.  Liberty  street ;  Ray- 
mond V.  Plarris,  class  of  1907,  118  E.  Park  ave- 
nue ;  John  Smallbrook  Howkins,  class  of  1897,  18 


THE    HOSPITAL    BULLETIN 


137 


E.  Liberty  street;  Everett  Iseman,  class  of  1909, 
1 1  E.  Jones  street;  Bartolo  Pedro  Oliveros,  class 
of  1883,  26  W.  Harris  street ;  S.  Latimer  Phillips, 
class  of  1885,  232  Bull  street;  Harry  Young 
Righton,  class  of  1907,  101  E.  Walberg  street; 
Marion  Russell  Thomas,  class  of  1902,  204  E. 
Oglethorpe  street. 

Statesboro — Lehman  \Y.  Williams,  class  of 
1909. 

Stilson — Henry  Newton  King,  class  of  1910. 

Thomasville — Harry  Ainsworth,  class  of  1901. 

VVadley — Ralph  Leland  Taylor,  class  of  191 1. 

Warthen— E.  T.  May,  class  of  1885. 

Waycross — Richard  C.  Dodson,  class  of  191 1. 


Dr.  J.  Whitridge  Williams,  class  of  1888,  has 
returned  from  a  trip  abroad,  and  is  at  his  cottage 
at   Watch  Hill,  R.  I. 


Dr.  John  R.  Winslow,  class  of  1888,  spent  the 
month  of  August  at  Gloucester,  Mass. 


Dr.  Charles  S.  Woodruff,  class  of  1891,  is 
spending  several  months  at  Port  Dalhouse,  On- 
tario, Canada. 


Dr.  John  Turner,  class  of  1892,  has  returned 
from  a  visit  to  New  York,  from  which  city  he 
motored  through  Connecticut. 


The  following  letter  has  been  received  from 
Dr.  Russell  H.  Dean,  class  of  1912: 

"Dear  Dr.  Winslow : 

"A  line  from  Florida  to  cool  you  off.  As  hot  as 
it  is,  it  cannot  touch  Baltimore  last  year,  but  it 
does  not  miss  it  far.  I  am  writing  to  impose  some 
trouble  on  you.  I  am  enclosing  a  check  for  two 
bones.  Please  put  half  to  the  Alumni  Association 
and  tack  the  other  on  the  subscription  list  of  the 
Hospital  Bulletin,  and  pardon  my  delay  in 
sending  the  former. 

"I  can*t  complain  of  overwork,  but  have  got 
together  enough  to  get  this  writing  paper.  Have 
given  six  anesthetics  and  removed  two  adenoids; 
the  rest  has  been  of  the  K  NmO,  variety  (3).  Not 
exactly  setting  the  world  afire,  but  I  could  not  see 
my  way  clear  to  the  ball  game  this  morning.  I  am 
enjoying  it,  as  I  have  no  board  to  pay  yet,  for  if 
I  did  I  expect  I  would  have  an  awful  uneeda  and 
sardine  appetite. 

"Hope  to  see  you  this  November  at  the  conven- 


tion. I  am  planning  to  get  there,  and  may  take  the 
hoard  if  it  is  convenient — as  Florida  board  is  No- 
vember 11,  1912— I  may  be  able  to  get  there  in 
time. 

"Hope  you  have  that  auto  now. 

"Kindest  regards  to  yourself  and  all,  including 
your  father.  Fraternally, 

"R.  H.  Dean,  Jr." 


Dr.  Albert  H.  Carroll  has  returned  from  a  trip 
to  the  United  States  Fisheries  Laboratories  at 
Woods  Hole,  Mass. 


Dr.  Roscoe  I).  McMillan,  class  of  1910,  of  Red 
Springs,  N.  C,  will  present  a  paper  before  the 
next  meeting  of  the  Atlantic  Coast  Line  Surgeons, 
to  be  held  in  Richmond.  The  title  of  his  paper 
will  be  "First  Aid  to  the  Injured,  with  Special 
Reference  to  Shock."  This  paper  will  appear 
later  in  The  Bulletix. 


Dr.  Nathan  R.  Gorter,  class  of  1879,  spent  part 
of  the  summer  in  a  camp  in  Canada  with  Dr. 
Thomas  S.  Cullen. 


Dr.  Perry  Carman,  class  of  1901,  has  been  vis- 
iting in  Atlantic  Citv. 


Dr.  Arnold  Dwight  Turtle,  class  of  1906,  First 
Lieutenant  Marine  Corps,  U.  S.  A.,  at  present 
surgeon  at  the  Presidio,  San  'Francisco,  ran  a 
losing  race  with  death  last  week,  when  he  raced 
across  the  continent  to  be  with  his  father,  Staff 
Quartermaster  Sergeant  Dwight  S.  Tuttle,  who 
died  three  days  before  Dr.  Tuttle  reached  Balti- 
more. Sergeant  Tuttle  is  survived  by  his  wife, 
two  sons.  Dr.  Tuttle  and  Amos  Tuttle,  and  three 
daughters,  Mrs.  John  G.  Lang  and  Misses  Olive 
and  Leslie  Tuttle  of  Baltimore. 


Dr.  Walter  S.  Carswell,  class  of  1895,  occupied 
his  cottage  at  Ocean  City  during  August. 


Dr.  Austin  F.  Robinson,  class  of   1903,  spent 
the  month  of  August  on  the  Maine  coast. 


At  the  fourteenth  annual  meeting  of  the  Amer- 
ican Proctologic  Society,  held  in  Atlantic  City 
June  3  and  4,  1912,  Dr.  Samuel  T.  Earle,  class  of 
1870,  of  Baltimore,  reported  a  case  of  primary 
tubercular  ulceration  of  the  right  buttocks,  which 


138 


THE    HOSPITAL    BULLETIN 


was  not  connected  with  the  rectum  by  a  fistulous 
tract.  In  this  respect  it  differed  from  the  one  re- 
ported by  him  in  his  work  on  "Diseases  of  the 
Anus,  Rectum  and  Sigmoid,"  Fig.  62,  page  201. 
It  was  excised  by  the  thermo-cautery  knife,  after 
which  it  healed  very  promptly. 

Dr.  Earle  also  reported  a  very  aggravated  case 
of  pruritus  ani,  which  had  resisted  local  applica- 
tions, autogenous  vaccines  and  treatment  by  the 
X-ray.  Under  local  anesthesia  he  found  an  ulcer 
over  the  posterior  commissure  just  above  the  in- 
ternal sphincter,  which  connected  on  each  side 
with  numerous  submucous  and  subcutaneous  su- 
perficial fistulae  which  enveloped  the  entire  anal 
margin  and  connected  with  each  crypt  of  Mor- 
gagni.  The  ulcer  was  incised,  the  scar  tissue  at 
its  base  removed,  and  the  fistulous  tracts  were  all 
opened  up.  There  was  only  an  occasional  twinge 
of  itching  following  the  operation,  and  he  made  a 
speedy  recovery. 


Dr.  J.  Fred  Adams,  class  of   1894,  is  at  his 
country  home  at  Catonsville  for  the  early  autumn. 


Dr.  Charles  C.  Harris,  class  of  1883,  of  Cathe- 
dral street,  spent  early  August  in  Atlantic  City. 


Dr.  John  G.  Jay,  class  of  1871,  spent  part  of 
August  in  Quebec  and  points  along  the  Sagueway 
river. 


Dr.  Cary  B.  Gamble,  class  of  1887,  recently 
made  a  canoe  trip  from  Biddeford  Pool  to  Me- 
gantic,  Maine. 


Dr.  John  McMullen,  class  of  1895,  passed  as- 
sistant surgeon  Public  Health  Service,  has  re- 
ceived notification  that  he  has  passed  the  exam- 
inations for  promotion  to  the  rank  of  surgeon. 
Dr.  McMullen  has  done  considerable  research 
work  in  diseases  affecting  immigrants. 


Dr.  Charles  W.  Mitchell,  class  of  1881,  read  a 
paper  on  the  feeding  of  infants  at  the  July  meet- 
ing of  the  Baltimore  County  Medical  Association. 


Dr.  C.  Urban  Smith,  class  of  1889,  spent  the 
summer  on  the  Severn. 


It  is  reported  that  Mrs.  J.  B.  Thomas  will  equip 
a  lecture  hall  at  the  Dental  School  of  the  Univer- 


sity of  Maryland  as  a  memorial  to  her  father,  Dr. 
James  Howell  Harris,  who  died  September  12, 
1910.  The  room  will  be  known  as  Harris  Hall. 
Dr.  Harris  was  connected  with  the  school  from  the 
time  it  was  organized  until  the  time  of  his  death. 
The  bronze  bust  of  Dr.  Harris,  which  was  pre- 
sented to  the  school  by  the  senior  class,  will  be 
placed  in  this  hall. 


Dr.  Robert  Garrett,  class  of  1890,  assistant  su- 
perintendent of  the  Maryland  Hospital  for  the 
Insane,  has  been  visiting  in  Atlantic  City. 


Dr.  Isaac  C.  Dickson,  class  of  1897,  who  has 
been  very  ill  with  appendicitis,  is  now  on  the  way 
to  recovery. 


Dr.  Howard  J.  Maldeis,  class  of  1903,  is  in  re- 
ceipt of  the  following  letter  from   Mr.  Alberto 
Garcia  de  Ouevedo,  of  the  second  year  class,  of 
Mayaguez,  Porto  Rico : 
"Dear  Dr.  Maldeis : 

"It  was  my  idea  to  write  you  ever  since  I  came 
down  home,  but  thinking  I  was  going  to  use  some 
of  your  always  busy  time,  I  hesitated  in  doing  so, 
but  I  do  it  now  with  the  greatest  pleasure. 

"Our  island  was  visited  a  few  months  ago  by 
bubonic  plague,  and  had  it  not  been  for  the  ac- 
tivity of  the  sanitation  department  of  the  island 
it  would  have  been  a  serious  matter,  but,  fortu- 
nately, everything  is  all  right  now.  The  people 
were  greatly  alarmed,  but  gradually  came  back  to 
their  nerves  again. 

"A  few  days  ago  I  looked  by  the  scope  the  Ba- 
cillus Pestis.  I  help  my  brother  a  little  in  his  labo- 
ratory, and  have  had  some  bacteriological  labora- 
tory experience  this  summer. 

"My  brother  sends  his  regards  to  you,  and 
"I  am,  sincerely, 

"A.  G.  de  Ouevedo." 


Dr.  Alexander  D.  McConachie,  class  of  1S90, 
spent  the  week  ends  of  July  at  Buena  Vista  and 
the  month  of  August  on  a  motor  trip  through  the 
North. 


Dr.  Gordon  Wilson,  Professor  of  Clinical  Med- 
icine, spent  the  month  of  August  in  Newport  and 
York  Harbor. 


THE    HOSPITAL    BULLETIN 


139 


The  Baltimore  News  contains  the  following 
item  concerning  Dr.  Marshall  Langton  Price,  class 
of  1902 : 

"Dr.  Marshall  L.  Price,  secretary  of  the  State 
Board  of  Health,  has  been  appointed  a  member  of 
the  committee  to  represent  the  American  Medical 
Association  at  the  joint  conference  to  be  held  at 
the  Willard  Hotel,  Washington,  September 
18-20,  to  consider  changes  or  modifications  in  the 
present  model  law  for  the  registration  of  vital 
statistics. 

"Besides  the  American  Medical  Association, 
other  organizations  to  take  part  in  the  conference 
are  the  American  Bar  Association,  the  American 
Public  Health  Association  and  the  conference  of 
Commissioners  on  Uniform  State  Laws.  The 
International  Congress  on  Hygiene  and  Demog- 
raphy will  be  held  in  Washington  the  following 
Monday,  and  it  is  thought  that  many  who  will  be 
present  for  the  one  event  will  also  attend  the 
other. 

"Those  on  the  committee  with  Dr.  Price,  who 
is  the  sole  Baltimore  representative,  are  Dr.  J.  M. 
McCormick,  secretary  of  the  State  Board  of 
Health,  Bowling  Green,  Ky.,  and  Dr.  William 
C.  Woodward,  health  officer  of  the  District  of 
Columbia." 


Dr.  J.  William  Ebert,  class  of  1912,  of  Luther- 
nlle,  Md.,  has  been  visting  in  Winchester,  Va. 


Dr.  Clarence  W.  Heffinger,  class  of  1881,  of 
Sykesville,  Md.,  is  visiting  in  Murray  Hill,  An- 
napolis. 


Among  the  University  alumni  practicing  in 
Indiana  are : 

Camden — Chas.  Edward  Scholl,  class  of  1873. 

Gary — James  Alexander  Craig,  class  of  1908, 
652  Broadway. 

Hagerstown — Chas.  I.  S.  Stotelmyer,  class  of 
1892. 

Indianapolis — Wm.  R.  Mayo,  class  of  1890,  715 
N.  Alabama  street;  Jos.  W.  Ricketts,  class  of 
1909,  Central  avenue  and  32d  street. 

Jamestown — Thomas  B.  Johnson,  class  of  1906. 

Logansport — John  Henry  Reed,  class  of  1885, 
416^  Broadway. 

Philadelphia— John  S.  Bell,  class  of  1884. 

Rockport — Arthur  White,  class  of  1854. 

Seymour — Grayson  R.  Gaver,  class  of  il 


Dr.  John  C.  Hemmeter,  class  of  1884,  spent  the 
month,  of  August  in  North  East  Harbor,  Maine, 
as  the  guest  of  Dr.  Thomas  E.  Satterthwaite  of 
New  York. 


Dr.  St.  Clair  Spruill,  class  of  1890,  is  spending 
a  vacation  on  the  Magothy  river. 


MARRIAGES 

Dr.  Maurice  Eubanks  Broadas  Owens,  class 
of  1910,  was  married  on  September  1,  1912,  to 
Miss  Maysville  Jane  Freeman,  daughter  of  Mrs. 
M.  W.  Freeman,  845  W.  Fayette  street.  Miss 
Freeman  left  Baltimore  August  25  and  reached 
Spokane,  Wash.,  September  1.  The  ceremony 
was  performed  there  at  the  residence  of  Dr.  A. 
Aldridge  Matthews,  class  of  1900,  and  brother  of 
Dr.  James  G.  Matthews,  class  of  1905.  Dr. 
Owens  is  located  at  Long  Lake,  about  30  miles 
from  Spokane,  and  he  and  Mrs.  Owens  went 
there  immediately  after  their  wedding. 

Mrs.  Owens  is  a  graduate  of  the  University  of 
Maryland,  department  of  pharmacy,  of  the  class 
of  1907,  and  stood  third  in  her  class.  Dr.  Owens 
was  then  a  student  in  the  medical  school,  and 
graduated  in  1910,  winning  the  gold  medal.  He 
then  served  for  a  year  in  the  University  Flospital, 
leaving  there  to  go  to  the  State  of  Washington. 
He  is  a  South  Carolinian  by  birth.  Mrs.  Owens 
is  a  Virginian.  She  is  also  a  graduate  of  the 
Shaftsbury  College  of  Expression,  and  was  prin- 
cipal of  the  Shakespeare  College  of  Expression. 


Dr.  Joseph  T.  Smith,  class  of  1872,  of  The 
Cecil,  is  at  Eaglesmere,  Pa.,  for  several  weeks. 


DEATHS 

Abel  Huston  Thayer,  class  of  1876,  died  at  his 
home  in   Grafton,  W.  Va.,   September  8,    1912. 

Dr.  Thayer  was  born  in  Garrett  county,  Mary- 
land, August  25,  1842,  the  son  of  Stephen  and 
Rebecca  (  McCleary)  Thayer,  and  was  descended 
from  American  Revolutionary  ancestors. 

He  began  the  study  of  medicine  at  Winchester 
Medical  College,  which  was  burned  during  the 
Civil  War.  He  served  as  surgeon  of  the  Sixth 
West  Virginia  Cavalry,  U.  S.  V.,  during  the  en- 
tire war,  serving  with  the  Army  of  the  Potomac 
and  with  Sheridan  in  the  Valley  of  Virginia,  and 
was  a  member  of  the  West  Virginia  Constitu- 
tional Convention  of  1872.    He  then  entered  the 


140 


THE    HOSPITAL    BULLETIN 


University  of  Maryland,  graduating  in  1876.  He 
began  the  practice  of  medicine  in  Webster,  \Y. 
Ya.,  and  then  located  at  Grafton,  where  he  re- 
mained until  his  death.  He  was  a  member  of 
the  West  Virginia  Legislature  of  1887,  and  again 
in  1889.  In  1901  he  was  president  of  the  West 
Virginia  State  Medical  Society,  and  in  1903  took 
a  special  course  in  the  New  York  Post-Graduate 
School  and  Hospital.  Dr.  Thayer  was  an  Episco- 
palian, and  was  for  years  senior  warden  of  St. 
Mathias  Protestant  Episcopal  Church  at  Grafton. 
He  was  a  member  of  the  Sons  of  the  Revolution, 
American  Medical  Association,  the  Military  Or- 
der of  the  Loyal  Legion,  Grand  Army  of  the  Re- 
public, Royal  Arch  Masons  and  National  Asso- 
ciation of  Railway  Surgeons. 

He  married  November  26,  1868,  Miss  Virginia 
Love  of  Grafton,  who  died  in  1885,  leaving  two 
children — Arthur  L.  and  Howard  B.  Thayer.  Dr. 
Thayer  married  again  October  30,  1890,  Miss 
Kate  Virginia  Samsell  of  Grafton,  by  whom  he 
had  six  children — Dorothy,  Katherine,  Marguer- 
ite, Helen.  Richard  S.  and  Abel  H.  He  is  sur- 
vived by  his  widow  and  four  children  of  the  sec- 
ond marriage  and  the  two  of  the  first. 


Dr.  William  Kirkwood  Robinson,  class  of  181)3, 
died  at  his  home,  306  Kingsley  Drive,  Los  An- 
geles, Cal.,  August  24,  1912,  after  an  illness  of 
several  months.  He  had  been  living  in  the  West 
for  some  years,  and  specialized  in  ear,  nose  and 
throat  work.  His  remains  were  cremated  in  Los 
Angeles,  in  accordance  with  his  request.  He  is 
survived  by  his  widow,  who  was  a  Miss  Yickers. 
of  Chestertown,  Md.,  daughter  of  the  late  Harri- 
son W.  Yickers,  and  his  father.  Dr.  R.  K.  Robin- 
son, Sharon,  Md. ;  one  brother,  John  A.  Robinson, 
Belair.  Md.,  and  three  sisters,  Mrs.  John  W. 
Staton,  Snow  Hill,  Md. ;  Mrs.  McAllister,  Balti- 
more, Md..  and  Mrs.  Ziegler,  Chambersburg,  Pa. 
Dr.  Robinson  was  43  years  of  age. 


BOOK  REVIEWS 


Practical  Anatomy.  An  Exposition  of  the 
Facts  of  Gross  Anatomy  from  the  Topo- 
graphical Standpoint  and  a  Guide  to  the  Dis- 
section of  the  Human  Body.  By  John  C. 
Heisler,  M.D.,  Professor  of  Anatomy  in  the 
Mcdico-Chirurgical  College  of  Philadelphia. 
With  366  illustrations,  of  which  225  are  in 


color,  by  E.  F.  Faber.  Philadelphia  and 
London :  J.  B.  Lippincott  Company.  1912. 
Leather ;  $4.50  net. 

From  an  experience  of  many  years  in  the  dis- 
secting-room the  reviewer  can  certify  to  the  wis- 
dom of  Heisler's  arrangement  of  his  material  in 
his  book  on  "Practical  Anatomy."  Undoubtedly 
the  best  way  to  study  anatomy  in  a  systematic 
manner  in  the  abstract  is  to  take  up  the  several 
systems  independently  of  each  other.  In  this  way 
the  student  gets  a  broad  grasp  of  the  subject,  but 
when  it  comes  to  the  dissecting-room  the  student 
is  confronted  with  another  problem.  Here  he 
finds  the  organs  and  structures  in  relationship 
with  each  other — the  body  in  an  orderly  whole, 
and  not  dissociated  as  in  textbooks.  Therefore, 
if  a  general  textbook  be  employed,  the  average 
student  finds  himself  at  sea  in  approaching  the 
subject.  Some  few  students  we  are  aware,  after 
bitter  experience,  learn  to  correlate  the  dissection 
by  skipping  about  in  the  book  before  them  and 
finding  out  what  structures  are  to  be  found  in  the 
region  under  study.  Heisler"s  idea  of  describing 
the  structures  as  the  student  reaches  them,  in  our 
judgment,  is  ideal  if  used  in  conjunction  with  a 
standard  textbook,  and  should  enable  the  dis- 
sector to  save  time  and  gain  a  more  intelligent 
grasp  of  human  anatomy  as  it  actually  presents 
itself.  The  division  of  the  contents  into  sections 
on  the  upper  limb,  the  lower  limb,  the  head  and 
neck  and  the  thorax  and  abdomen  cannot,  from  a 
practical  view,  be  improved  upon.  The  reviewer 
has  long  since  learned  that  medical  students'  inter- 
est in  any  subject  is  proportionate  as  they  can  see 
the  practical  utility  resulting  therefrom.  Heisler 
has  attempted  to  supply  this  incentive  by  includ- 
ing in  smaller  type  such  information,  either  med- 
ical or  surgical,  as  has  a  practical  bearing  on  the 
part  under  discussion.  In  order  to  familiarize  the 
users  with  the  desirability  of  simplicity  and  uni- 
formity in  anatomical  nomenclature  the  Basle 
Anatomical  Nomenclature  is  used  wherever  feasi- 
ble, and  where  not  employed  is  included  between 
parenthesis.  Explicit  directions  are  everywhere 
to  be  found  as  to  the  best  and  simplest  method  of 
making  the  dissection.  The  illustrations,  many 
of  which  are  colored,  are  excellently  executed, 
true  to  nature  and  made  from  original  dissections 
by  the  author.  It  supplies  a  long-felt  need  in  the 
dissecting-room,  is  practical,  accurate,  sufficiently 
full  for  its  purposes  and  dependable. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 
PRICE    $1.00    PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  608  Professional  Building,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.    VIII 


BALTIMORE,  MD.,  OCTOBER  IS,   1912. 


No.  8 


A  SUMMER  CRUISE  ON  THE  SPANISH 
MAIN. 


By  Randolph  Winslow,  M.D. 


2.     Colon,  Panama  and  the  Canal  Zone. 

Colon  is  situated  on  an  indentation  of  the  coast 
of  the  Isthmus  of  Panama,  called  Limon  Bay. 
This  bay,  though  on  the  Atlantic  side,  looks  to- 
wards the  north,  and  at  certain  seasons  of  the 
year  is  an  unsafe  harbor.  In  order  to  obviate  this 
serious  disadvantage  and  to  protect  the  entrance 
to  the  Canal,  the  United  States  has  built  a  break- 
water about  two  miles  in  length,  which  to  a  very 
large  extent  converts  this  open  roadstead  into  a 
land-locked  harbor.  If  this  is  not  sufficient  to  ac- 
complish the  purpose,  another  breakwater  upon 
the  opposite  side  will  also  be  built,  leaving  only  a 
narrow  entrance  through  which  ships  will  pass. 
Strong  fortifications  are  also  being  constructed  to 
defend  the  canal  from  attack  from  the  sea.  Colon 
was  formerly  called  Aspinwall,  and  was  built  upon 
a  marshy  island,  scarcely  above  sea  level.  Like 
most  Spanish-American  towns,  its  streets  were 
unpaved,  and  were  the  depositories  of  all  kinds  of 
filth.  The  first  effort  of  the  United  States  after 
securing  control  of  the  Canal  Zone  was  to  clean 
up  these  pestilential  cities  and  towns,  and  to  ren- 
der them  safe  from  yellow  fever,  malaria  and 
<  >ther  zymotic  diseases.  The  streets  of  Colon  and 
Panama  have  therefore  been  raised,  curbed  and 
macadamized  or  paved,  and  will  compare  favor- 
ably with  cities  of  similar  size  in  our  own  coun- 
try. 'Water-works  have  been  established  and  an 
abundant  supply  of  pure  water  furnished  for  both 
drinking  and  bathing,  while  previously  the  drink- 
ing water  was  obtained  by  catching  rain  water  in 
cisterns,  which  were  also  the  breeding  places  of 
mosquitoes.  Colon  has  about  17,000  inhabitants. 
of  a  very  mixed  character,  whites  of  varying 
shades,  negroes,  Chinese,  Hindoos,  and  people  of 
almost   everv   race   and   color.     The   houses   are 


mostly  wooden  and  are  ramshackly  in  appearance, 
though  there  are  a  few  good  stone  buildings.  The 
town  derived  its  importance  from  being  the  start- 
ing point  of  the  Panama  Railroad,  and  will  cer- 
tainly continue  to  increase  in  population  and  pros- 
perity from  its  location  at  the  entrance  of  the 
Panama  Canal.  Although  Colon  and  Panama  are 
within  the  Canal  Zone,  they  are  exempted  from 
the  control  of  the  United  States  except  in  the  mat- 
ter of  sanitation  and  of  preserving  order.  The 
railroad  tracks  separate  Colon  from  Cristobal, 
which  is  the  American  settlement  and  is  entirely 
within  the  jurisdiction  of  the  L'nited  States.  Here 
the  Canal  Commission  has  its  great  commissary 
establishment,  laundry  and  many  other  offices. 
The  Colon  Hospital  was  built  by  the  French  and 
came  under  the  control  of  the  Americans  in  1904. 
It  consists  of  many  detached  buildings  situated  on 
the  waterfront,  and  some  of  them  actually  erected 
on  piles  in  the  bay.  It  is  said  to  have  accommoda- 
tions for  500  patients.  There  are  several  long 
wdiarfs  at  Colon  and  Cristobal  at  which  large  ships 
can  dock,  and  there  are  usually  six  or  more  steam- 
ers taking  on  or  discharging  cargoes  all  the  time. 
The  Panama  Railroad  was  opened  in  1855  and  ex- 
tends 47  miles  from  Colon  to  Panama.  As  first 
constructed,  it  was  a  narrow-gauge  road  running 
over  swampy  ground  to  the  hills,  but  it  has  now 
been  relocated  upon  a  higher  level,  and  is  a  broad- 
gauge,  double-tracked,  well-ballasted  road.  It 
runs  nearly  parallel  with  the  canal,  but  at  only  a 
few  points  is  the  canal  actually  visible  from  the 
train.  All  along  the  line  of  the  railroad  one  sees 
the  towns  in  which  the  employes  of  the  Canal 
Commission  dwell,  the  houses  being  raised  from 
the  ground  in  order  to  permit  a  free  circulation 
of  air  under  as  well  as  through  them.  They  are 
usually  two  stories  in  height,  surrounded  by  porti- 
coes well  screened,  and  situated  on  an  eminence; 
and  every  effort  is  made  to  make  the  life  of  the 
employes  comfortable  and  happy.  The  heavy 
work  is  mostly  done  by  West  Indian  negroes,  but 
the  overseers   and  bosses   are   white  Americans. 


142 


THE   HOSPITAL   BULLETIN 


As  has  been  stated,  the  county  is  flat,  marshy  and 
covered  with  jungle  for  25  miles,  when  it  becomes 
hilly.  These  hills  are  the  continuation  of  the 
Andes  mountains,  but  do  not  attain  any  great  alti- 
tude. Gold  Hill  being  the  highest  point  through 
which  the  canal  is  cut,  somewhat  more  than  500 
feet  in  elevation.  One  of  the  detached,  more  or 
less  conical,  hills  is  called  Balboa  hill,  as  it  is  sup- 
posed that  Balboa  first  saw  the  Pacific  Ocean 
from  its  summit  in  1 5 13.  At  Las  Cascadas  a  bat- 
talion of  marines  is  stationed,  and  at  Empire  the 
10th  infantry  has  its  post.  These  are  elevated, 
healthy  locations,  and  the  camps  are  kept  in  beau- 
tiful condition.  The  Canal  Zone  is  policed  by 
fine-looking  mounted  officers,  who  go  about  their 


though  a  line  is  now  being  built.  There  are  no 
detached  residences  in  Panama  as  far  as  I  could 
see,  but  the  people  live  over  stores  or  other  utili- 
tarian buildings.  Earthquakes  do  not  occur  on 
the  Isthmus,  hence  the  houses  are  several  stories 
in  height.  As  has  been  said,  the  streets  are  now 
well  paved  and  are  kept  scrupulously  clean,  but 
formerly  they  were  filthv  and  ill-kept.  The  popu- 
lation is  very  mixed,  mostly  not  white,  and  with 
a  deepseated  dislike  of  the  American  gringo.  As 
an  illustration  of  this,  on  the  4th  of  last  July 
there  were  athletic  sports  held  in  the  citv,  at 
which  American  soldiers,  unarmed,  were  present. 
Two  soldiers  having  a  personal  quarrel,  and  prob- 
ably under  liquor,  went  upon  a  vacant  lot  to  settle 


FRONT    STREET,    COLON. 


duties  in  a  very  businesslike  manner.  Descending 
on  the  Pacific  side  we  reach  Panama  in  21/  hours 
from  the  time  of  leaving  Colon.  The  conductors 
and  engineers  of  the  trains  are  Americans,  and 
the  nasal  twang  of  the  Yankee  is  very  much  in 
evidence.  Panama  city  is  situated  on  a  bay  of 
the  same  name  and  has  a  population  of  between 
30,000  and  40,000.  It  is  quite  a  bustling  town, 
with  many  stores,  narrow  streets  and  scrawny 
horses  attached  to  dilapidated  carriages.  A  ride 
within  the  city  costs  10  cents  a  passenger,  but 
that  means  in  American  coin.  I  paid  a  driver  the 
amount  he  asked  and  supposed  I  had  given  him 
the  correct  fare,  but  I  had  paid  in  Panamanian 
money,  which  is  one-half  the  value  of  our  cur- 
rency, and  he  was  mad  all  through  about  it. 
There  are  no  street  cars  at  present  in  Panama, 


their  dispute  in  the  usual  manner,  when  they  were 
fired  on  by  the  native  police.  Of  course,  their 
comrades  came  to  their  aid  and  a  melee  ensued, 
in  which  two  Americans  were  killed  and  several 
wounded.  It  is  thought  that  this  was  a  political 
act  to  force  American  intervention  in  order  to 
prevent  the  election  of  the  popular  candidate  for 
the  presidency.  It  was  with  great  difficulty  that 
the  American  troops  were  kept  from  entering  the 
town  and  killing  the  police.  For  the  size  of  the 
city  the  police  force  is  very  large,  though  the  in- 
dividual members  of  it  are  very  small.  The  Amer- 
icans with  no  arms,  except  bayonets,  were  anxious 
to  attack  the  whole  Panamanian  police  force, 
armed  with  modern  rifles.  Our  Government  has 
demanded  satisfaction  for  the  attack  on  its  citi- 
zens and  the  punishment  of  those  who  were  the 


THE   HOSPITAL   BULLETIN 


'4.5 


ringleaders  in  the  outrage.  The  native  women 
wear  their  hair  down  their  backs  and  a  silk  shawl 
around  their  shoulders  in  the  Spanish  fashion ; 
while  children  are  frequently  seen  clad  only  in  the 
garb  of  nature.  Some  of  the  churches  and  the 
cathedral  are  of  interest,  as  well  as  of  antiquity. 
There  are  ancient  and  useless  fortifications  over- 
looking the  sea,  dating  from  the  early  days  of  the 
city.  The  present  city,  however,  is  not  the  first 
one  of  the  same  name,  but  is  located  about  five 
miles  from  old  Panama,  which  was  sacked  and 
destroyed  by  the  English  freebooter,  Sir  Henry 
Morgan,  in  1670.  The  original  city  of  Panama 
was  founded  in  1511),  and  after  its  destruction  by 


Pacific  entrance  of  the  canal.  Here  one  finds 
steamship  lines  to  Peru,  Chile  and  the  other  coun- 
tries on  the  western  coast  of  South  America,  as 
well  as  the  Pacific  Mail  steamships  plying  be- 
tween Panama,  Central  America,  Mexico  and 
San  Francisco. 

The  name  Balboa  is  very  prominent  on  the 
Isthmus ;  I  have  already  mentioned  Balboa  hill 
and  Balboa  port,  and  one  is  constantly  reminded 
of  the  historic  personage  who  first  gave  the  Pacific 
1  Icean  its  name,  as  the  standard  coin  is  the  balboa, 
equal  to  50  cents  in  our  money.  Immediately  con- 
tiguous to  Panama  is  the  American  settlement  of 
Ancon,  where  the  administration  headquarters  are 


CENTRAL   AVENUE.    PANAMA,    AND    NATIONAL    HANI  l. 


Morgan  was  rebuilt  on  its  present  location ;  it  is, 
therefore,  the  oldest  city  of  continental  America. 
At  one  time  it  was  the  port  through  which  the 
Spanish  treasure  came  from  Peru  and  the  western 
coast ;  subsequently  it  lost  much  of  its  importance, 
which  was  in  a  measure  regained  on  the  opening 
of  the  railroad  in  1855. 

With  the  completion  of  the  interoceanic  canal 
in  the  near  future,  it  is  bound  to  become  one  of 
the  important  ports  of  the  world.  Panama  Bay 
is  shallow  and  there  is  a  daily  variation  of  21  feet 
in  the  tide,  so  that  the  water  comes  against  the 
sea  wall  of  the  city  at  full  tide,  and  recedes  a  long 
distance  at  the  ebb.  Ships,  therefore,  cannot  ap- 
proach the  city,  but  land  at  Balboa,  which  is  the 


located.  Here  also  is  the  large  and  comfortable 
Hotel  Tivoli,  built  by  and  under  the  control  of  the 
Canal  Commission.  The  fare  is  $5  per  diem ;  but 
one  gets  a  good  airy  room,  clean  sheets  and  bed 
linen,  and  beds  that  are  not  overtenanted,  as  well 
as  good  meals.  It  is  said  that  these  essential 
requisites  cannot  be  obtained  in  the  hotels  in  the 
native  town.  The  view  from  the  hotel  porch  is 
beautiful,  as  the  blue  waters  of  the  bay  are  spread 
out  before  us,  dotted  with  islands  of  emerald 
green  and  animated  with  sail  and  steam  boats  of 
various  kinds.  Still  higher  on  the  hill  back  of  the 
hotel  is  the  great  Ancon  Hospital,  erected  by  the 
French  and  taken  over  by  the  Americans  in  1904. 
This  hospital  consists  of  many  detached  buildings, 


U4 


THE    HOSPITAL    BULLETIN 


usually  of  one  story,  but  some  are  two  stories  in 
height,  severely  plain  in  construction,  with 
screened  windows  and  doors  through  which  an 
abundant  flow  of  air  is  permitted.  The  Americans 
have  erected  but  few  additional  buildings,  and  the 
institution  is  a  monument  to  the  excellence  of  the 
French  physicians  and  builders.  Its  original  cost 
was  several  million  dollars.  The  capacity  of  this 
hospital  is  about  1500  beds,  400  of  which  are  for 
surgical  cases.  The  Americans  took  charge  about 
June,  1904,  and  up  to  the  time  of  my  visit  on 
August  23,  1912,  a  little  more  than  eight  years, 
123,000  patients  have  been  admitted.  Dr.  Her- 
rick,  the  chief  surgeon,  very  courteously  took  Dr. 


physicians  or  to  the  hospital,  but  are  turned  over 
to  the  Canal  Commission.  The  staff  are  treated 
very  well,  however,  as  the  chief  physicians  re- 
ceive $6000  a  year,  besides  comfortable  houses 
and  equipages,  and  the  junior  officers  are  also  well 
paid.  It  was  a  great  pleasure  to  me  to  find  Dr. 
Howard  V.  Dutrow,  class  of  1904,  at  work  at  the 
hospital,  and  I  am  indebted  to  him  for  many 
courtesies.  Dr.  James  C.  Perry,  class  of  1885,  is 
chief  quarantine  officer  of  the  Isthmus,  and  is  an 
important  factor  in  preventing  the  introduction 
and  spread  of  infectious  diseases. 

The  Canal  Zone  extends  five  miles  on  each  side 
of  the  canal  and  is  under  the  exclusive  control  of 


PALM    AVENUE.    CRISTOBAL,    CANAL   ZONE. 


Felty  of  Hartford,  Conn.,  and  myself  through 
the  surgical  wards  and  showed  us  some  very  in- 
teresting cases,  especially  of  fractures  treated  with 
intramedullary  splints.  Not  only,  however,  are 
medical  and  surgical  patients  treated,  but  the  va- 
rious specialties — eye,  ear,  throat  and  nose, 
gynecology,  and  even  obstetrics — are  under  the 
care  of  skilled  attendants.  The  reputation  of  the 
hospital  has  become  so  extended  that  pay  patients 
from  the  surrounding  countries  as  well  as  from 
Panama  seek  the  skill  of  the  physicians  and  sur- 
geons attached  to  the  hospital. 

While  I  was  there  the  wife  of  the  present  Presi- 
dent of  Panama  was  a  patient  in  the  pay  pavilion. 
The  fees  for  the  private  patients  do  not  go  U<  the 


the  United  States.  There  were  and  are  native 
villages  within  this  strip,  but  many  of  them  will 
be  covered  with  water  when  Gatun  Lake  is  filled, 
and  they  have  already  been  removed  to  higher 
land.  Most  of  the  American  settlements  will  also 
be  abandoned,  and  the  Zone  will  be  to  a  large  ex- 
tent depopulated,  only  leaving  a  sufficient  force  of 
employes  to  care  for  the  canal.  I  did  not  have 
time  and  opportunity  to  get  a  good  idea  of  the 
country  or  to  estimate  its  advantages  as  a  place 
of  residence  or  business.  There  did  not  seem  to 
be  much  arable  land  in  the  portion  through  which 
I  traveled,  nor  did  I  see  anything  under  cultiva- 
tion except  bananas.  The  canal  employes  receive 
their    food    supplies    entirely    through    the   cold- 


THE    HOSPITAL    BULLETIN 


145 


storage  plant  at  Colon,  which  must  be  replenished 
every  two  weeks.  The  foliage,  while  abundant, 
was  not  especially  pretty,  nor  were  the  flowers  of 
the  same  delicacy  and  beauty  as  in  more  temperate 
climes.  There  were,  however,  some  curious  and 
attractive  flowering  plants.  1  presume  there  must 
be  an  abundant  bird  and  animal  life  in  the  less 
frequented  regions,  but  they  were  not  in  evi- 
dence in  the  parts  I  visited.  As  to  the  climate,  it 
is  hot,  but  not  more  so  than  that  of  Baltimore  in 
mid-summer,  and  there  is  usually  a  good  breeze, 
but  the  great  humidity  is  very  unpleasant  and  de- 
pressing to  those  who  are  not  acclimated.  Some 
of  our  officials  have  now  lived  there  ten  or  more 
years,  and  not  only  appear  to  live  comfortably, 
but  to  enjoy  life. 


INITIAL    ADDRESS    TO    THE 
AND  SENIORS. 


JUNIORS 


Delivered    by    Ernest    Zueblin,    M.D. 


"Not  enjoyment  and  not  sorrow- 
Is  our  destined  end  or  way ; 
But  to  act,  that  each  tomorrow 
Finds  us  farther  than  today." 

The  pleasures  of  the  seaside,  or  of  the  tool 
mountains,  or  the  recreation  at  your  homes,  per- 
haps, has  come  to  a  close.  The  possibility  of  alle- 
viating the  sorrows  of  suffering  mankind  will  com- 
pensate you,  I  hope,  for  the  regret  you  feel  in  leav- 
ing so  many  pleasant  scenes  behind.  You  have  an- 
swered the  call  of  your  Alma  Mater  in  assembling 
again  in  her  halls.  I  wish  to  extend  a  cordial 
welcome  to  all  my  pupils.  After  the  idleness  of 
the  vacation  you  feel  the  necessity  of  resuming 
your  studies.  You  know  that  much  work  has  to 
be  done  before  you  reach  the  rank  of  an  accom- 
plished physician.  For  some  of  you  it  means  the 
entry  into  a  new  field  of  activity,  and  I  venture 
(luring  the  sometimes  tedious  preparatory  studies 
of  former  years  you  longed  for  the  moment  to 
get  into  closer  contact  with  the  professional  du- 
ties, the  application  of  your  knowledge  to  the  re- 
lief of  suffering  patients.  For  some  of  you  this 
year  means  the  completion  of  your  studies,  after 
the  careful  instruction  you  owe  to  the  knowledge, 
experience  and  personality  of  your  previous  teach- 
ers, among  whom  stands  prominently  Prof.  C. 
W.  Mitchell.  It  is  with  regret  that  you  have 
heard  that  the  accumulation  of  work  in  the  inter- 


est of  the  University  induced  your  former  teacher 
to  restrict  his  teaching  in  medicine  for  the  benefit 
of  the  juniors  only.  As  you  may  be  accustomed 
to  the  methods  of  my  distinguished  predecessor, 
you  may  regret  this  change.  But  every  teacher's 
aim  is  the  same ;  it  is  to  see  you  advancing  on  the 
way  to  become  a  distinguished  physician,  gifted 
with  knowledge,  experience  and  untiring  energy 
in  the  fight  against  human  disease,  and  provided 
with  all  the  necessary  qualities  that  will  assure 
you  a  prominent  standing  among  the  members  of 
the  medical  profession,  as  well  as  a  numbering 
among  the  benefactors  of  humanity.  So,  in  the 
acceptance  of  the  honor  conferred  upon  me  by 
the  decision  of  the  Board  of  Regents  and  by  the 
members  of  the  Faculty  of  Physic  of  our  famous 
Alma  Mater,  let  me  hope  that  our  work,  based  on 
mutual  understanding,  will  be  successful  for  all 
of  us. 

Medical  science  has  a  peculiar  attraction  for 
her  disciples;  like  a  mountain  we  see  it  rise  from 
the  plain,  and  we  wish  to  reach  the  top  in  order 
to  obtain  from  there  a  more  distinct  view  of  the 
world.  On  the  way  to  this  elevated  position  we 
have  to  overcome  many  difficulties,  and  on  the 
stony  path  there  are  moments  when  our  strength 
seems  to  fail,  and  where  a  word  of  encourage- 
ment, of  good  cheer  from  our  guide  sets  free  new 
resources  of  unknown  energy.  In  the  course  of 
your  studies  you  learn  how  your  knowledge  is 
built  up  from  little  facts,  which  by  themselves 
seem  unimportant,  but  which  are  quite  significant 
in  the  final  outcome  from  cause  and  effect.  Medi- 
cal education  is  a  process  of  evolution — the  con- 
tinuous development  of  the  student  into  the  prac- 
titioner. The  final  result  depends  greatly  on  the 
personal  contact  of  the  teacher  with  his  pupil. 
It  is  greatly  influenced  by  the  interest  and  en- 
thusiasm of  the  teacher  in  his  work  and  the  in- 
dustry displayed  by  the  student.  A  certain 
affinity  between  teacher  and  pupil  has  to  be 
created ;  mutual  understanding  in  the  ways  and 
aims  of  education  has  to  be  cultivated  in  order 
to  accomplish  a  good  result.  The  teacher  has  to 
reply  on  a  certain  collaboration  on  the  part  of 
his  students.  Thoroughness,  perseverance  and 
love  for  the  work  has  to  be  fostered  in  the  stu- 
dent. Considered  from  this  point  of  view,  medi- 
cal teaching  comprises  an  eminent  task,  which 
becomes  still  more  difficult  in  the  hands  of  an 
outsider.  Just  as  medical  science  has  become  a 
benefit  to  the  whole  of  humanity,  so  the  methods 


1 46 


THE    HOSPITAL    BULLETIN 


of  its  teaching,  not  restricted  to  one  particular 
seat  of  learning,  find  their  way  everywhere.  What 
seems  good  for  one  place  may  be  helpful  to  an- 
other if  the  proper  conditions  prevail.  So,  my 
friends,  in  beginning  our  work  I  hope  that  my 
experience  with  eminent  clinical  teachers  of  your 
own  and  of  the  old  country  will  turn  out  to  the 
benefit  of  our  Alma  Mater  and  of  her  students. 
Knowing  that  our  work  is  based  on  the  accom- 
plishments of  our  ancestors  and  predecessors,  we 
try  to  continue  only  with  the  aim  to  adapt  it  to 
the  present  and  future  requirements.  So  this 
does  not  mean  that  I  discredit  the  work  already 
accomplished ;  only  it  means  that  in  the  course  of 
time  I  wish  to  develop  your  clinical  knowledge 
on  the  basis  you  owe  to  your  previous  teachers. 
The  medical  profession  can  be  viewed  under 
very  different  angles;  To  some  men  it  means  a 
successful  way  for  making  money;  for  the  ac- 
quisition of  all  the  means  that  contribute  to  the 
happiness  of  life.  It  is  justified  that  every  work 
receives  its  true  reward,  be  it  good  or  bad.  If 
you  analyze  the  lives  of  medical  men  who,  owing 
to  their  work  and  to  their  personal  qualities,  have 
reached  eminence,  you  will  find  the  medical  pro- 
fession meant  more  to  them  than  a  safe,  success- 
ful, prominent  position  in  life.  Physical  as  well 
as  spiritual  life  is  a  process  of  evolution,  and  a 
process  greatly  influenced  by  education,  surround- 
ings and  ethical  training.  I  assume  that  all  of 
you.  brought  up  and  strengthened  in  the  prin- 
ciples of  religion,  remember  that  one  of  the  prin- 
cipal manifestations  of  spiritual  life  and  one  of 
the  most  important  commandments  is  that  of 
charity.  To  my  mind,  there  is  hardly  any  other 
profession  where  charity  and  science  amalga- 
mated can  do  more  for  humanity.  Science  taken 
for  itself  may  be  compared  to  a  limelight  pene- 
trating into  the  darkness  of  ignorance,  but  leav- 
ing the  heart  cold.  In  the  contact  with  human 
suffering  we  often  feel  depressed  and  discour- 
aged, and  our  wish  to  abolish  all  evil  is  felt  in- 
tensely. But  sentiments  alone  avail  nothing ; 
scientific  help  and  sentiments  combined  can  re- 
lieve human  sufferings.  Charity  blended  with 
medical  science  and  experience  is  the  source  from 
which  we  can  draw  new  energies,  destined  to 
adorn  the  existence  of  mankind.  Daily  expe- 
rience shows  us  the  truth  that  a  good  man  alone 
can  become  a  good  physician,  a  man  with  a  firm 
character,  gifted  with  that  idealism  that  holds 
out  against  all  difficulties  of  life.     A  physician 


remaining  all  the  time  on  the  ground  of  thor- 
ough science  may  inspire  his  circle  of  students 
and  patients  with  admiration,  and  his  knowledge 
may  be  a  great  blessing  for  his  patient.  Yet  he 
is  apt  to  consider  suffering  human  beings  as 
mere  material  for  observation  and  experimenta- 
tion, and  he  may  even  try  in  his  cases  remedies 
which  will  not  stand  the  test  of  ethical  judgment. 
His  presence  sends  forth  a  cold,  bright  light:  it 
will  not  warm  the  heart  of  his  human  patient, 
who  is  in  need  of  sympathy  and  kindness  as  well 
as  of  medical  treatment,  if  no  word  of  sympathy 
or  kindness  for  the  patient  accompany  his  actions. 
How  different  the  atmosphere  that  emanates 
from  the  physician  who  brings  to  the  bedside 
knowledge  and  psychological  understanding  of 
the  suffering !  Without  many  words  the  under- 
standing between  patient  and  physician  is  estab- 
lished. In  the  former  the  comforting  feeling  is 
aroused  that  he  can  trust  his  doctor  in  everything. 
And  even  if  our  efforts  to  save  a  human  life  are 
of  little  success,  the  refined  physician  can  render 
great  services  in  alleviating  the  patient's  physical 
and  mental  sufferings  when  he  is  about  to  de- 
part from  this  life.  If  we  consider  the  role  of  the 
family  physician  to  whose  faithful  services  whole 
families  are  indebted  for  his  devotion  and  skill 
where  he  is  not  only  consulted  in  medical  ques- 
tions alone,  but  where  his  advice  is  highly  accred- 
ited, can  money  be  the  just  compensation  for  such 
help?  The  financial  equation  remains  often  be- 
low the  standard,  but  even  then  it  does  not  equal 
the  satisfaction  experienced  in  the  physician's 
soul,  knowing  that  he  has  done  his  best  for  his 
cases.  "Xoblesse  oblige,"  if  not  immediately,  it 
will  later  on.  If  we  investigate  into  the  motifs 
of  generous  donators.  we  may  not  unfrequently 
find  that  the  example  of  an  unselfish,  persevering 
physician  created  in  the  mind  of  the  donor  the 
desire  for  such  noble  actions.  So  it  will  also  be 
your  task  by  your  work,  by  your  learning  and 
your  professional  services  to  impress  on  your 
patients  the  commandment  of  charity,  and  in  do- 
ing so  you  may  be  of  great  help  in  the  progress 
of  science  also. 

Science  gradually  directs  us  to  a  higher  stand- 
point for  observation  of  mankind.  Just  as  daily 
experience  shows  the  truth  of  the  old  maxim 
"mens  sana  in  corpore  sano,"  we  observe  how  a 
diseased  body  transforms  the  mentality  of  chronic 
suffering  patients.  We  feel  compassion  for  them, 
and  all  our  efforts  are  tended  to  alleviate  their 


THE    HOSPITAL   BULLETIN 


'47 


physical  and  psychical  condition.  The  high  edu- 
cation given  to  the  physician  has  rendered  him 
as  solid,  as  resistant  as  a  rock,  against  which  the 
waves  of  ignorance,  of  superstition,  of  selfish- 
ness and  ingratitude  of  the  public  are  of  no  avail. 
During  the  years  of  studies  you  have  reared  and 
elevated  among  your  fellow-students  the  senti- 
ments of  friendship,  of  collegiality,  which  does 
not  admit  thoughts  of  animosity  or  jealousy. 
When  you  have  entered  a  practical  life,  you  will 
never  foresake  these  noble  convictions  which 
adorn  your  professional  life.  No  doubt  science 
has  an  elevating  influence  on  yourself,  and  if  the 
progress  of  medical  science  represents  a  glorious 
history,  written  with  the  blood  of  its  promoters, 
you  certainly  acknowledge  these  results  of  un- 
tiring work  of  past  generations.  Science  does  not 
only  include  the  obligation  of  recognition ;  it 
kindles  our  energy  to  contribute  to  the  best  of 
our  ability  to  its  further  progress.  Among  the 
alumni  of  our  University  you  certainly  remember 
the  name  of  Dr.  James  Carroll,  who  offered  his 
life  as  a  martyr  for  the  progress  of  medical 
science.  His  assertion,  "Truth  will  prevail," 
should  also  enter  into  our  convictions,  and  we 
should  be  able  to  accomplish  for  humanity  as 
much  as  he  did.  My  friends,  if  ethical  training 
and  medical  science  corrobate  each  other,  let  me 
hope  that  you  will  show  the  world  what  a  mind 
enriched  with  acquisitions  of  medical  science, 
>trengthened  by  exercise  and  led  and  inspired  by 
an  ardent  and  sensitive  heart  can  accomplish  for 
humanity. 

With  such  a  view  into  your  future  let  us.  my 
friends,  begin  the  work.  Which  are  the  neces- 
sary requirements  I  have  to  expect  from  you  ? 
Thoroughness,  perseverance  and  love  for  your 
work  have  already  been  briefly  mentioned.  In 
a  task  in  which  your  future  happiness,  your  pro- 
fessional success  is  at  stake,  I  have  to  insist  on 
the  necessity  of  pursuing  your  medical  studies  in 
this  clinic  also  thoroughly.  I  cannot  lay  enough 
stress  on  this  quality,  as  it  seems  to  me  the  "one" 
essential  for  the  medical  man — one  factor  upon 
which  your  future  depends.  You  may  analyze 
the  factors  which  contributed  to  the  fame  of 
clinical  teachers,  and  you  will  always  find  that 
they  were  thorough  in  the  least  details  of  their 
work.  Hardly  any  fact,  even  seemingly  unim- 
portant to  the  patient,  escaped  their  attention  in 
taking  the  history.  Thoroughness  characterizes 
their  examination  of  the  whole  bodv,  where  all 


organs  may  suffer.  After  the  exhaustion  of  the 
means  of  clinical  physical  examination,  they  try 
to  unite  all  findings,  all  knowledge,  every  expe- 
rience,  and  a  kind  of  medical  instinct  allows 
them  to  separate  primary  cause  from  secondary 
consequences  as  much  as  possible.  Their  diag- 
nosis dives  to  the  bottom  of  the  cause  of  disease, 
and  after  a  careful  consideration  of  prognosis  the 
treatment  is  before  all  causal,  if  necessarily  symp- 
tomatic and  prophylactic.  In  a  process  where 
analysis  is  followed  by  synthesis,  where  clinical 
findings  and  didactic  knowledge  or  the  symptom- 
atology, of  pathology  complete  each  other, 
where  the  body  of  the  patient  does  no  longer 
mean  an  organ  in  which  darkness  prevails  and 
wherefrom  only  little  information  is  transmitted 
10  its  outer  surface.  As  long  as  our  physical 
means  are  not  yet  able  to  transilluminate  com- 
pletely the  human  organism,  we  are  still  obliged 
to  train  our  senses,  our  mind,  so  as  to  penetrate 
the  secrets  of  the  body  by  mental  analysis.  The 
future  will  show  that  the  patients  will  learn  to 
distinguish  very  well  the  thorough  physician 
from  his  colleague,  who  does  not  think  it  worth 
while  to  concentrate  his  interest  on  his  patient's 
disease,  and  who,  without  a  careful  examination, 
resorts  to  symptomatic,  in  many  instances  to  un- 
successful, treatment.  I  know  that  untrained 
human  beings  are  naturally  inclined  to  avoid  diffi- 
culties. In  education  it  is  one  of  the  most  im- 
portant tasks  to  create  in  the  pupil  that  sentiment 
of  responsibility  in  the  work  to  be  accomplished, 
to  develop  in  the  pupil  the  courage  to  tackle  diffi- 
culties directly  and  with  enthusiasm  (nee  aspera 
terrent).  It  means,  no  doubt,  a  hard  task  not  to 
follow  the  tendency  toward  lesser  resistancv,  not 
to  take  it  easy.  History  and  daily  observation 
demonstrate  that  the  world  belongs  to  the  con- 
queror. Also,  with  reference  to  the  success  of 
the  medical  student  in  doing  thorough  work,  he 
will  not  only  merit  the  recognition  of  the  patients, 
the  encouragement  of  his  teachers,  but  most  valu- 
able of  all  will  be  the  personal  satisfaction  expe- 
rienced by  the  success  in  treatment  of  disease. 
It  may  appear  easier  in  the  beginning  not  to  care 
much  about  the  quality  and  quantity  of  the  work- 
accomplished,  but  later  on  the  results  and  conse- 
quences of  the  work  done  are  quite  different. 
Once  started  into  medical  practice,  no  more 
within  reach  and  control  of  the  medical  teacher, 
the  practitioner  will  learn  his  mistakes  at  the 
risk    of    his    patient's    welfare.      Thoroughness 


M8 


THE    HOSPITAL    BULLETIN 


means  an  important  habit  to  adopt  during  your 
studies,  but  which  will  become  second  nature 
and  then  pay  itself  manyfold  by  the  success  it 
warrants.  If  the  fatal  results  in  surgery  are 
often  caused  by  very  little  errors  and  small  neg- 
lects, so  in  medicine  carelessness  may  cause 
almost  similar  consequences.  So,  my  friends,  I 
shall  judge  your  fitness  for  a  good  final  grading 
by  the  evidences  you  give  of  your  thoroughness 
in  your  studies  and  in  the  examination  of  the 
cases. 

Before  we  begin  our  work  let  us  consider  a 
certain  outline  of  our  clinical  studies,  first  for  the 
junior  men,  then  that  of  the  seniors.  After  the 
completion  of  your  previous  studies  it  is  most  im- 
portant to  master  the  principles  of  physical  diag- 
nosis and  to  make  extensive  use  of  your  expe- 
rience, first  in  normal  cases  among  yourselves, 
and  later,  when  you  have  become  familiar  with 
the  physical  signs  of  normal  conditions,  you  will 
train  your  senses  on  your  patients.  Then,  not- 
withstanding the  excellent  preparatory  instruction 
given  to  the  student  as  soon  as  he  enters  the 
practical  clinical  studies,  it  seems,  that  he  has  first 
to  be  taught  to  use  his  senses.  His  power  for 
close  observation  of  the  patient  has  to  be  devel- 
oped, as  the  outward  observation  of  the  patient 
already  in  many  instances  can  furnish  important 
information  of  the  case.  The  ear  requires  the 
subtle  training  of  the  musician  to  differentiate 
the  quality,  the  tonality  of  the  sounds  transmitted 
t<>  the  surface  of  the  body.  The  delicate  touch 
of  the  fingers  has  to  be  trained  to  differentiate 
the  outlines,  the  resistancy,  the  qualities  of  vibra- 
tion of  the  underlying  organs.  The  acuity  of 
smell  has  to  be  educated  in  order  that  pathological 
changes  imparted  to  the  air,  may  not  be  over- 
looked. All  these  requirements,  in  addition  to 
your  practical  training  in  the  manipulation  of  in- 
struments and  apparatus,  in  the  chemical  and  mi- 
croscopical clinic,  diagnostic  methods,  etc.,  are 
important  factors  in  medical  diagnosis,  and  they 
are  obtained  only  by  an  assiduous,  thorough  train- 
ing in  the  methods  of  physical  diagnosis.  Hand 
in  hand  with  this  instruction  in  following  the 
medical  clinic  you  will  reach  the  understanding 
of  the  cases,  of  the  methods  of  examination,  of 
differential  diagnosis  and  the  principles  of  treat- 
ment. Frequent  study  of  your  textbooks  on  in- 
ternal medicine  will  complete  your  knowledge  of 
the  clinical  features  of  the  presented  cases.  So, 
with   vour  collaboration,   1    hope   that   our  work 


will  be  so  successful  that  whenever  questions  are 
addressed  to  you  they  will  be  answered  readily, 
so  showing  the  senior  men  that  your  knowledge 
increases  every  day,  and  that  you  are  keen  to 
enter  into  friendly  competition.  The  necessity 
of  practical  and  theoretical  understanding  in  clini- 
cal medicine  is  obvious.  In  lectures  on  didactic 
medicine  you  will  gradually  get  acquainted  with 
the  terminology,  symptomatology,  pathological 
anatomy,  diagnosis,  prognosis  and  treatment  of 
human  internal  disease.  If  we  briefly  outline  the 
task  of  this  year  for  you,  the  senior  men,  your 
instruction  is  partly  didactic,  mostly  practical. 
Certain  chapters  of  internal  medicine  require  a 
more  detailed  discussion.  In  the  previous  year, 
I  assume,  you  have  had  clinical  cases  demon- 
strated by  my  predecessor,  Professor  Mitchell. 
Xow,  each  one  of  you  will  in  turn  be  assigned  one 
clinical  case,  which  you  will  thoroughly  examine 
and  then  submit  your  clinical  findings  to  me  for 
control,  for  discussion  of  the  differential  diag- 
nosis, prognosis  and  your  plan  of  treatment.  This 
will  be  done  here  in  public,  in  presence  of  the 
junior  students.  From  time  to  time  you  will  re- 
port on  the  course  of  treatment  of  your  cases ; 
also  on  the  changes  of  its  clinical  features.  Grad- 
ually seeing  that  you  have  mastered  the  general 
routine  examination,  it  will  be  the  aim  of  our  con- 
ferences to  enter  more  in  detail  of  the  clinical 
aspect  of  cases,  comparing  them  with  the  material 
you  have  already  seen  and  with  pathological 
specimens,  so  that  at  the  end  of  your  term  you 
will  have  gained  a  thorough  knowledge  of  the 
different  internal  diseases,  didactically  as  well  as 
practically.  With  your  clinical  instruction  at 
this  place  and  the  clinical  material  from  the  poli- 
clinic, a  great  field  of  work  is  opened  to  you,  and 
in  appreciating  your  zeal,  your  understanding  and 
your  earnest  work,  I  wish  to  help  you  all  to  be- 
come thorough,  well-experienced  practitioners  in 
internal  medicine.  So,  gentlemen,  the  plan  I  have 
briefly  outlined  means  a  great  task,  but  I  count  on 
your  earnest  perseverance  in  your  work,  and 
gradually  I  expect  to  watch  your  further  progress, 
so  let  me  hope  that,  following  the  device  of  our 
Alma  Mater.  Omnia  probate  qnoci  boiuan  est 
tenetc,  we  will  accomplish  our  duties. 


Dr.  Russell  Hardy  Dean,  class  of  1912,  of 
Jacksonville.  Fla.,  has  been  forced,  because  of 
ill-health,  to  go  to  the  mountains  of  North  Caro- 
lina for  relief. 


THE    HOSPITAL    BULLETIN 


i4'» 


REASONABLE   AND    PLEASURABLE. 


By  X  vi  ii  \v  Wixsi  n\v.  Al.l ' 


Travel  has  been  made  so  safe,  reasonable  ami 
comfortable  these  days  that  everybody  should,  if 
possible,  become  acquainted  with  his  own  conn 
try.  Instead  of  hibernating  at  a  summer  or  moun- 
tain resort,  sitting  around  and  gossiping,  better 
use  can  be  made  of  the  time  at  your  disposal  by 
visiting  new  scenes  and  getting  new  ideas.  With 
this  object  in  view,  accompanied  by  Mrs.  Winslow, 
T  sailed  September  11,  [912,  from  Baltimore  on 
the  Merchants  &  Miners'  steamship  Suwannee 
for  Savannah  and  Jacksonville.  This  vessel  is  one 
of  the  best  appointed  coastwise  steamers  that 
sails  out  of  any  Atlantic  port,  being  fully 
equipped  with  every  convenience  necessary  to  the 
comfort  of  its  passengers  and  providing  a  sub- 
stantial and  excellent  cuisine. 

The  trip  down  the  bay  was  made  at  night,  and 
the  next  morning  by  8  found  us  passing  between 
the  capes  into  the  ocean.  Thursday  was  spent  on 
the  ocean,  as  well  as  a  part  of  Friday,  the  Savan- 
nah River  being  entered  about  9  P.  M.  on  the  lat- 
ter day  and  the  boat  docked  by  11,  where  it  re- 
mained until  7  P.  M.  Saturday,  sailing  thence  to 
Jacksonville,  which  was  reached  10  A.  M.  Sun- 
day morning. 

Savannah  is  situated  on  the  south  bank  of  the 
river  of  the  same  name,  18  miles  from  the  sea, 
on  a  level  plateau  about  50  feet  above  sea  level. 
It  is  a  very  attractive  city,  with  numerous  parks 
and  some  very  pretentious  buildings.  Every- 
where you  turn  you  run  into  a  small  square  or 
park,  not,  as  in  Baltimore,  posted  with  signs  of 
"Keep  Off  the  Grass,"  but  given  over  to  children 
as  play  and  airing  grounds.  The  streets  are  well 
paved,  mostly  with  vitrified  bricks,  and  well-made 
roads  lead  into  the  surrounding  country,  thus 
offering  opportunity  for  enjoyable  auto  and 
buggy  drives. 

The  show  place  of  Savannah  is  the  Ronaven- 
ture  Cemetery,  with  its  magnificent  live  oaks, 
from  which  hang  in  festoons  streams  of  Spanish 
moss.  While  in  this  city  we  called  upon  Miss 
Raines,  a  graduate  of  the  University  Hospital 
Training  School  for  Nurses,  now  superintendent 
of  Oglethorpe  Sanitarium,  and  were  shown 
through  the  hospital,  which  accommodates  about 
35  patients.  It  is  a  very  attractive  and  well 
equipped  building.     While  there  1  met  Or.  Ray- 


mond V.  Harris,  class  of  [907,  who  took  us 
around  the  city  in  his  motor  car.  We  traversed 
miles  of  well-paved  streets  and  well-made  COlin 
try  roads,  passing  through  substantial  develop 
ments,  dotted  with  attractive,  modern  homes.  The 
courthouse,  city  hall,  custom-house  and  postoffice 
are  all  modern  and  architecturally  pleasing.  Sa- 
vannah leaves  the  impression  of  a  conservative, 
but  substantial  town,  not  going  ahead  too  rapidly, 
but  steadily  and  naturally.  This  impression  was 
afterwards  verified  when  I  learned  that  in  point 
of  export  trade  Savannah  ranks  seventh,  being 
next  in  importance  to  Baltimore. 

The  River  Queen  has  made  the  Savannah 
River  famous.  This  lady,  who,  together  with 
her  brother,  keeps  a  river  lighthouse,  never  fails, 
night  or  day,  to  salute  a  passing  vessel — at  night 
by  waving  a  lantern,  by  day  a  handkerchief.  By 
some  a  romance  is  supposed  to  be  attached  to  the 
action,  and  the  common  story  is  that  the  woman 
became  demented  by  the  loss  of  her  lover  at  sea, 
and  since  then  has  saluted  each  vessel,  hoping  that 
he  may  yet  pass  by  and  recognize  her.  The  story 
as  related  is  very  pretty  and  has  a  natural  ring, 
but  is  a  myth,  the  woman  being  entirely  rational 
and  never  having  had  a  lover — at  any  rate,  one 
who  was  lost  at  sea. 

Jacksonville  is  a  12-hour  sail  from  Savannah. 
It  is  situated  on  the  west  bank  of  the  beautiful 
St.  Johns  River,  25  miles  from  the  ocean.  It  is 
very  progressive,  and  jumping  by  leaps  and 
bounds  both  in  population  and  commercial  impor- 
tance. Everything  going  into  or  coming  out  of 
lower  Florida  must  pass  through  its  walls,  thus 
making  of  it  a  commercial  mart  of  great  impor- 
tance. It  is  a  large  lumber,  citrus,  turpentine  and 
produce  shipping  center.  The  streets,  though 
narrow,  are  well  paved,  mostly  with  vitrified 
brick.  In  the  business  section  are  to  be  seen  a 
number  of  modern  office,  banking  and  trust  build- 
ings. Here  are  also  to  be  found  numerous  parks. 
full  of  bright-colored  flowers,  live  oaks,  syca- 
mores, chinatree,  magnolia  and  palm  trees.  The 
banana  tree  grows  in  this  latitude,  but  only  ex- 
ceptionally bears  fruit.  The  residential  districts 
are  attractive  and  contain  quite  a  number  of  im- 
posing houses. 

While  here  I  called  up  Dr.  Norman  M.  Heggie, 
class  of  1502.  who  is  a  leading  eye,  ear,  nose  and 
throat  specialist.  He  has  built  up  a  large  practice, 
and  we  are  glad  to  announce  is  held  in  the  greatest 
respect  by  his  associates  and  clientele.     He  took 


15° 


THE    HOSPITAL    BULLETIN 


us  in  his  automobile  around  the  city  and  a  long 
ride  to  Pablo  Beach,  18  miles  from  Jacksonville, 
on  the  Atlantic  Ocean.  On  this  ride  we  passed 
through  miles  of  pine  forest,  from  the  trees  of 
which  turpentine  was  being  extracted.  At  Jack- 
sonville there  is  a  large  ostrich  and  alligator  farm. 
It  was  indeed  a  rare  sight  to  see  over  700  alliga- 
tors, of  all  ages  and  sizes,  in  one  enclosure. 

While  I  was  in  Jacksonville  I  had  the  pleasure 
of  seeing,  besides  Dr.  Heggie,  Dr.  Russell  Dean. 
class  of  1912;  Dr.  James  D.  Love,  class  of  1897: 
Dr.  Charles  Leitner  Jennings,  class  of  1906,  and 
caught  a  glimpse  of  Dr.  George  Walter,  class  of 
1910,  as  he  flew  past  in  his  auto.  Dr.  Robert  H. 
McGinnins,  class  of  1897,  and  Dr.  James  B.  Par- 
ramore,  class  of  1909.  were  out  of  the  city.  I 
called  up  Drs.  Charles  Edward  Terry,  class  of 
1903 ;  Fred  J.  Waas,  class  of  1905,  and  Dr.  Louis 
Stinson.  class  of  191 1.  by  phone,  but  could  get  no 
aibwer,  so  was  compelled  to  forego  the  pleasure 
of  seeing  them. 

With  Miss  Nettie  Flannigan,  class  of  1901,  of 
the  University  Hospital  Training  School  for 
Nurses,  who  is  superintendent  of  the  De  Soto 
Sanitarium,  we  spent  a  very  pleasant  afternoon 
automobiling  around  the  surrounding  country. 

A  dav  was  also  spent  in  St.  Augustine,  the  old- 
est city  in  the  United  States.  It  is  40  miles  dis- 
tant from  Jacksonville,  located  on  the  Matanzas 
River,  and  is  a  place  of  great  historic  interest. 
Here  is  to  be  seen  the  Old  Spanish  Mission  Build- 
ing, without  doubt  the  oldest  building  in  America, 
the  records  of  which  are  preserved  in  the  archives 
of  the  Church  of  Rome.  The  Ponce  de  Leon  and 
Alcazar  hotels  are  magnificent  samples  of  old 
Spanish  architecture,  and  the  "Fountain  of 
Youth."  discovered  by  Ponce  de  Leon  on  Easter 
Sunday  of  15 13.  a  quaff  of  whose  waters  was  sup- 
posed to  restore  youth,  never  fails  to  interest.  It 
possesses,  however,  one  peculiarity  —  the  water 
rises  and  falls  without  any  apparent  reason  or 
cause.  Old  Fort  Marion,  the  only  example  of 
medieval  fortification  in  existence  on  this  conti- 
nent, was  built  in  1565  by  Menendez,  and  named 
San  Juan  de  Pinos.  It  was  rebuilt  as  Fort  Marion 
during  the  seventeenth  century.  The  City  Gates, 
like  those  of  Panama,  remain  to  tell  of  the  Old 
World  civilization  that  once  dwelt  within  the  city 
walls ;  the  slave  market,  which  was  never  so  used 
save  in  rare  instances ;  the  narrowest  street  in  the 
United  States,  but  seven  feet  wide  at  its  east  end; 
the  Cathedral  of  St.  Augustine,  built  in  1797:  the 


old  Franciscan  Monastery,  now  the  arsenal  of  the 
Florida  National  Guard,  and  the  houses  of 
coquina,  a  shell  formation — one  after  the  other 
present  a  panorama  of  never-ending  interest  and 
entertainment. 

The  return  voyage  was  over  the  same  route. 
Outward  bound  Dr.  Adam  Clark  Walkup,  class 
of  1909,  of  Mcintosh.  Fla..  was  among  the  ship's 
company.  He  had  been  spending  a  few  weeks' 
vacation  in  New  York,  and  was  on  his  way  home. 
Dr.  Walkup  was  looking  in  the  best  of  health,  and 
told  me  he  had  been  very  successful  and  was 
building  up  a  good  practice. 

Although  the  trip  was  replete  with  many  new 
and  novel  sights,  and  was  thoroughly  enjoyable 
from  beginning  to  end,  my  greatest  pleasure  and 
satisfaction  was  in  the  evident  prosperity  and  hap- 
piness of  our  alumni  now  located  in  those  cities. 


Prof.  Randolph  Winslow  is  in  receipt  of  the 
following  letter  from  Dr.  Edward  L.  Meierhof, 
class  of  188 1 : 

"My  Dear  Dr.  Winslow  : 

"Enclosed  please  find  my  promised  instalment 
as  a  contribution  to  the  P.  E.  F.  I  have  just  re- 
turned from  abroad,  where  I  had  attended  the 
clinics  at  Jena,  Yienna  and  Berlin.  The  old  town 
of  Jena  I  found  very  interesting.  It  is  the  home 
of  the  great  Zeiss  Optical  Works,  which  cover 
about  three  of  New  York  city  blocks,  or  more. 
Some  of  the  profits  of  this  institution  are  given 
to  the  support  of  the  university  and  hospitals.  It 
is  also  the  home  of  Ernst  Haechel.  whose  popular 
book,  'The  Riddle  of  the  Universe,'  has  helped 
to  spread  his  name  and  fame.  Yienna  has  a  new 
hospital  devoted  to  nose  and  throat  diseases.  It 
is  splendidly  equipped,  especially  for  teaching. 
It  is  part  of  the  Allgemeines  Krankenhaus.  and 
is  attended  by  many  'Ainerikanische  Aertzte.' 

"Berlin  is  a  lively  and  hustling  town.  There 
are  not  as  many  of  our  countrymen  pursuing  the 
furtherance  of  clinical  knowledge  as  in  Yienna. 
although  I  profited  very  much  by  my  stay  in 
Berlin,  as  well  as  in  the  other  places. 

"With  best  regards,   from 

"Yours  sincerely. 

"E.  L.  Meierhof.'' 

P.  S. — I  think  you  are  the  youngest  man  I  have 
had  the  pleasure  of  knowing. 


THE    HOSPITAL    BULLETIN 


15 r 


THE  USE  OF  IODINE  IN  OBSTETRICAL 
PRACTICE. 


(In  264  cases  with  no  infection.) 


From  the  Clinic  of  Dr.  Sprigg  and  Dr.  Keller, 
Columbia  Hospital,  Washington,  D.  C. 


By  Willis  Linn,  M.D.,  Resident  House 
Surgeon. 


Following  the  marked  success  of  the  use  of 
iodine  in  preparation  of  surgical  cases,  it  occurred 
to  us,  as  perhaps  it  has  to  others  in  the  same  line 
of  work,  that  its  use  in  obstetrical  cases  might  be 
of  benefit.  The  objection  was  raised  by  some 
that  the  use  of  iodine  in  the  external  genitalia 
would  be  far  too  irritating.  We  have  not  found 
that  it  causes  any  irritation,  the  patients  complain 
for  a  moment  directly  after  it  is  applied,  but  aside 
from  this  transitory  burning  the  irritation  caused 
is  negative.  The  method  pursued  is  as  follows: 
As  soon  as  the  patient  is  placed  on  the  delivery 
bed  the  pubic  hairs  are  clipped  with  scissors ; 
shaving  is  unnecessary  and  causes  much  more  in- 
convenience after  delivery.  The  parts  are  then 
dried  of  mucus  and  any  amniotic  fluid  that  may 
be  present,  if  the  membranes  are  ruptured,  a 
50  per  cent,  solution  of  tincture  of  iodine  in  alco- 
hol is  then  applied,  commencing  at  the  um- 
bilicus and  including  the  lower  portion  of  the 
abdomen,  the  entire  genitalia  well  down  on  the 
buttocks  and  inner  side  of  legs  and  thighs.  A 
sterile  vulval  pad  is  then  put  in  place,  and  the  re- 
mainder of  the  preparation  consists  in  merely 
placing  the  patient  on  a  sterile  bed  pan  and  plac- 
ing the  sterile  covers  on.  These  last  are  not 
done,  however,  until  bulging  is  marked.  In  using 
the  flat  sterile  bed  pan  in  delivery  cases,  the  Kelly 
pad  is  done  away  with  altogether.  Time  and  ex- 
pense are  thus  both  saved  and  the  pan  is  much 
easier  to  sterilize  than  is  the  pad.  The  method 
is  quick.  The  slop  and  dirt  of  the  old  bichloride 
preparation  is  done  away  with,  and  the  inflamma- 
tion which  certainly  occurred  in  some  cases  when 
using  the  bichloride  is  overcome.  We  have  had 
no  cases  of  inflammation  following  the  use  of 
iodine.  Dr.  Charles  Duffy  of  Pittsburgh  tells  me 
that  he  has  seen  two,  but  that  the  use  of  glyceride 
of  starch  applied  locally  cleared  them  up  in  less 
than  24  hours.  In  hospital  maternity  work, 
where  cases  are  constantlv  being  sent  in,  which 


have  been  examined  by  septic  fingers  before  de- 
livery, we  separate  the  labia  as  far  as  possible 
and  carry  a  sponge  on  a  hemostat  well  up  into 
the  vagina,  thus  applying  the  iodine  to  the  in- 
terior. Of  course,  in  these  cases,  we  are  going 
against  the  advice  of  Bovee,  who  showed  the 
surgical  world  that  iodine  acts  best  on  a  dry 
held,  but  we  have  gotten  results  that  prove  that 
iodine  will  and  does  sterilize  the  vaginal  canal. 
It  is  doubtlessly  better  on  a  dry  field,  but  in  cases 
that  have  been  previously  examined  it  is  well  to 
use  it  in  the  interior  as  well.  In  that  large  class 
of  the  cities'  poor  and  lower  classes,  where  a  phy- 
sician is  often  not  called  until  delivery  is  all  but 
complete,  it  has  proven  very  satisfactory ;  and 
in  the  private  home,  where  trained  assistants  are 
so  often  wanting  and  the  old  method  was  hard  to 
carry  out,  it  should  be  most  satisfactory. 

I  see  no  reason  why  it  could  not  be  intrusted  to 
midwives,  and  in  this  way  might  save  not  a  few 
lives  from  that  most  dire  of  obstetrical  results — 
puerperal  sepsis.  The  50  per,  as  it  is  now  com- 
monly called,  does  not  end  its  usefulness  in  ob- 
stetrics here,  for  after  the  cord  has  been  tied  and 
cut  its  application  to  the  end  of  same  assures  at 
least  a  clean  field.  This  will  not  appeal  to  men  in 
hospital  work  where  the  technique  is  certain, 
but  in  the  "private  home"  and  in  the  hands  of 
the  midwife  it  seems  to  us  that  it  would  not  be 
amiss.  We  do  not  claim  for  the  method  that  it 
is  original  with  us,  but  it  does  surely  possess  the 
following  advantages : 

1.  It  is  quick. 

2.  It  is  sure. 

3.  It  shows  the  exact  field  of  operation  which 
has  been  sterilized. 

4.  It  can  be  done  without  assistance  from 
anyone. 

5.  Aside  from  the  temporary  burning  it 
causes  no  inconvenience  to  the  patient. 

6.  It  does  away  with  the  wet,  sloppy  "bi- 
chloride bath." 

7.     It  brings  results. 

May  19,  1912. 


The  engagement  is  announced  of  Dr.  William 
Gwynn  Queen,  class  of  1909,  of  Arlington,  Md., 
t<>  Miss  Loretta  Wholey,  daughter  of  Mr.  and 
Airs.  William  Wholey,  of  Staunton,  \"a.  The 
marriage  will  be  performed  at  St.  Francis  Cath- 
olic Church  on  Tuesday,  October  15,  191 2. 


152 


THE    HOSPITAL    BULLETIN 


THE   HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Me   u  ine  and  Surgery 

PUBLISHED  BV 

THE  HOSPITAL  BULLEI  IN   COMPANY 

608  Professional  Building 

Baltimore,  Via 


Subscription  price,     .     .     .     $1.00  per  annum  in  advance 

Reprints  furnished  at  cost.     Advertising  rates 

submitted  upon  request 


Nathan  Winslow,  W.D.,  Editor 


Baltimore,  October  15,  1912. 


BERI-BERI    CLINIC. 


Professors  Zueblin  and  Spear  will  hold  in  the 
amphitheater  of  the  University  Hospital  on  Mon- 
day, October  21,  at  8.30  P.  M.,  a  clinic  on  beri- 
beri, with  exhibition  of  cases.  All  those  inter- 
ested in  this  disease,  rare  in  this  section,  are  cor- 
dially invited  to  be  present. 


DR.  J.  HOLMES  SMITH,  Sr. 


The  editor  of  The  Bulletin'  cannot  let  pass 
the  retirement  of  Dr.  Smith  from  active  practice 
in  order  to  devote  his  entire  time  to  the  depart- 
ment of  anatomy  without  recording  our  senti- 
ments concerning  the  act.  A  protocol  was  is- 
sued by  the  Regents  of  New  York  that  medical 
schools  to  be  registered  in  that  State  must  have 
at  least  six  full-paid  instructors  in  the  laboratory 
branches.  In  order  to  meet  this  command,  Dr. 
Smith,  without  a  murmur,  consented  to  forego 
the  remuneration  of  a  large  and  lucrative  surgical 
practice.  Such  acts  of  unselfishness  marks  a 
man — a  patriot  not  alone  to  the  cause  of  educa- 
tion, but  also  to  an  ideal,  a  greater  Universitv  of 
Maryland.  The  Bulletin  appreciates  the  mo- 
tive which  induced  Dr.  Smith  to  devote  his  atten- 
tion to  pedagogical  work,  and  desires  to  take  this 
opportunity  in  wishing  him  many  years  of  use- 
fulness in  his  newly-mapped-out  career. 


THE  OPENING  OF  THE  SESSION  1912-13. 


The  loOth  annual  session  of  the  medical  de- 
partment of  the  University  of  Maryland  began  on 
October  1.     At  this  time  i.t  is  impossible  to  state 


how  many  students  will  be  in  attendance,  as  the 
enrollment  is  still  going  on.  It  is  thought,  how- 
ever, that  there  will  be  fewer  new  students  than 
usual,  owing  to  regulations  enforced  by  the  New 
York  Board  of  Education.  There  have  been  many 
applications  for  advanced  standing  from  students 
of  other  colleges,  who  wished  to  obtain  better 
clinical  facilities  than  those  ottered  by  the  institu- 
tions in  which  they  had  taken  their  first  two  years' 
work,  but  we  were  unable  to  accept  them,  owing 
to  the  New  York  regulations.  These  were  not 
conditioned  students,  but  men  who  had  success- 
fully completed  their  first  two  years  in  respectable 
schools  which  we  have  hitherto  recognized  and 
which  we  still  believe  to  be  good  and  honorable 
schools.  We  think  that  the  New  York  ruling  in 
regard  to  these  schools  is  unduly  drastic,  but  we 
have  obeyed  their  mandate.  We  are  glad  to  an- 
nounce that  the  State  Board  of  Medical  Examiners 
has  taken  supervision  of  the  entrance  require- 
ments of  medical  students  in  this  State,  and  that 
Professor  (  His  of  the  Baltimore  Polytechnic  In- 
stitute has  been  appointed  official  examiner  of  the 
credentials  of  prospective  medical  students.  Stu- 
dents are  therefore  only  admitted  to  the  medical 
colleges  when  they  present  certificates  from  Mr. 
Otis  giving  them  premission  to  do  so.  The  ad- 
mission of  students  is  therefore  entirely  out  of  the 
hands  of  the  deans,  which  simplifies  the  situation 
very  much.  The  uncertainty  in  regard  entrance 
requirements  and  the  rapid  advancement  of  edu- 
cational qualifications  will  undoubtedly  deter  many 
from  the  study  of  medicine,  and  the  entering 
classes  will  probably  be  smaller  than  usual  this 
winter. 


IMPR(  >YEMENTS    AND    CHANGES. 


Much  has  been  done  since  the  last  session  to 
put  the  medical  school  on  a  better  basis.  First  of 
all,  six  full-time  salaried  instructors  have  been 
secured  ;  and  a  new  professor  of  medicine,  who  is 
also  a  full-time  teacher,  for  this  winter  at  least. 
The  anatomical  and  chemical  theaters  have  been 
beautifully  renovated,  and  a  fine  museum  has  been 
established.  A  balopticon  has  been  purchased  ami 
will  be  set  up  in  the  lower  hall. 

Davidge  Hall  has  not  only  had  a  coat  of  paint, 
but  a  steam-heating  system  has  been  introduced. 
New  shelving  has  been  put  in  the  library,  thereby 
greatly  increasing  its  capacity.  Many  new  books 
have  been  donated  and  some  bought.     The  main 


HE    HOSPITAL    BULLETIN 


'53 


lobb)  of  the  medical  school  has  had  a  fine  terazzo 
floor  laid.  .Much  painting  and  calcimining  has 
been  done  in  the  lecture-rooms  and  laboratories. 
A  new  clinical  laboratory  has  been  established  at 
the  hospital.  The  Eormer  lying-in  hospital  has 
been  converted  into  a  polyclinic  for  general  medi- 
cal and  children's  diseases.  New  apparatus  has 
been  purchased,  and  a  new  spirit  of  enthusiasm 
and  of  optimism  prevails. 


Til!':  PATHOLOGICAL  FUND. 


Festina  lente,  or  make  haste  slowly,  is  doubtless 

a  safe  adage,  but  it  has  its  disadvantages  when  ap- 
plied practically.  The  above  aphorism  is  forcibly 
impressed  on  the  mind  of  the  writer  by  the  pres- 
ent state  of  the  endowment  fund.  It  certainly 
does  not  make  haste  in  any  direction  except  slow- 
ly. The  best  that  can  be  said  of  it  is  that  it  does 
progress  slowly.  Hope  deferred  maketh  the  heart 
sick.  Please  do  not  defer  your  contributions  un- 
til our  heart  becomes  too  sick  for  recovery.  All 
of  which  means :    Please  help  us  out. 

CONTRIBUTION     BY    CLASSES. 

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1871 35  00 

1872 81  84 

!873 44i  83 

1874 5  00 

1875 5  00 

1876 115  00 

1877 10  00 

1880 5  00 

1881 250  OO 

1882 310  00 

1883 40  00 

I 884 40  00 

1885 235  00 

1886 100  00 

1888 50  00 

1889 100  00 

1890 175  00 

1892 150  00 

1893 40  00 

!894 135  o° 

1895 155  00 

1896 52  00 

1897 80  00 

1898 105  00 

1899 =;o  00 


1900 21 5  00 

I  '  I  >  I 260  OO 

I  00_' 33O  OO 

1903 ■ 3*5  00 

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[908 20  00 

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1 010 50  0  1 

191 1  Terra  Mariae 3  50 

1012  Club  Latino  Americano 25  00 

Total  subscriptions  to  <  let.  1,  1912.. $10,250  17 

NEW   SUBSCRIPTIONS   IN    SEPTEMBER. 

Dr.  Win.  I\.  White,  1902 $25  00 

Dr.  Watson  S.  Rankin,  1901 20  00 

Class  of   1872 1 1  84 

Class  of    1873 11  83 

Total   $68  67 


1)1 


ERNEST  ZUEBLIN. 


Some   time  back   The   Bulletin    notified  its 
readers  that  Dr.  Charles  VV.   Mitchell  was  com- 


I)R.    ERNEST    ZUEBLIN 


154 


THE   HOSPITAL   BULLETIN 


pelled,  owing  to  press  of  other  duties,  to  give  up 
the  chair  of  Practice  of  Medicine  and  limit  his 
efforts  in  medical  teaching  entirely  to  his  first 
love,  the  children's  department.  Coincidently 
with  this  announcement  there  appeared'  the  call 
to  the  vacancy  and  its  acceptance  by  Dr.  Ernest 
Zueblin,  together  with  a  short  sketch  of  the  ap- 
pointee's life  and  qualifications,  and  the  prognos- 
tication that  he  was  the  right  man  for  the  place. 
A  closer  acquaintance  with  our  new  professor 
has  strengthened  us  in  our  previous  opinion  of 
him.  We  are  particularly  impressed  with  the 
method  he  has  employed  in  organizing  his  depart- 
ment. The  slightest  detail  does  not  seem  too 
small  to  merit  attention.  He  is,  according  to  a 
slang  expression,  "on  the  job,"  and  if  his  enthus- 
iasm and  earnestness  are  criteria,  we  bespeak  for 
the  medical  department  of  the  University  of 
Maryland  a  prestige  second  to  none  in  the  coun- 
trv. 


ITEMS 


The  most  recent  work  published  by  a  member 
of  the  faculty  of  medicine  is  a  Manual  of  Prac- 
tical Physiology,  bv  Prof.  John  C.  Hemmeter, 
LLD..  Ph.D. 

A  number  of  highly  interesting  and  valuable 
reviews  and  comments  upon  Professor  Hem- 
meter's  Manual  of  Practical  Physiology  have 
been  received.  These  are  by  authorities  so  emi- 
nent and  who  give  their  opinion  so  rarely  that 
the  editor  believes  they  should  be  brought  to  the 
notice  of  the  readers  of  the  Hospital  Bulletin. 

One  is  by  Prof.  H.  J.  Hamburger,  the  pro- 
fessor of  physiology  at  the  Royal  University  of 
Groningen,  who  writes: 

"May  I  heartily  congratulate  you  on  the  com- 
pletion of  this  excellent  work?  It  will  be  a  splen- 
did adviser  to  me  and  I  shall  not  fail  to  recom- 
mend it  to  my  students  immediately  at  the  begin- 
ning of  the  next  course  in  the  warmest  manner." 

Dr.  E.  Laqueur  has  published  a  review  of  it  in 
the  Biochemisches  Centralblatt.  He  begins  in  the 
following  manner: 

"This  Manual  of  Physiology  deserves  to  attract 
the  attention  also  of  German  students  and 
readers ;"  and  after  reviewing  the  various  chap- 
ters in  some  detail  he  continues : 

"An  extensive  series  of  vivisection  operations, 
though  clearly  and  concisely  given,  will  hardly  be 
capable  of  execution  by  German  students,  in  the 


time  at  their  disposal,  but  their  concise  yet  com- 
prehensive presentation  is  well  suited  to  give  the 
student  a  picture  of  the  physiological  operations 
which  are  so  important  for  our  modern  concepts. 

"The  illustrations  are  highly  instructive,  those 
from  the  Woods  Hole  Laboratory  of  the  United 
States  Bureau  of  Fisheries  being  so  simple,  yet 
clear,  that  one  cannot  fail  to  detect  the  experi- 
enced work  of  Professor  Hemmeter." 

Professor  Brubacker  of  Jefferson  Medical  Col- 
lege: 

"In  the  first  place,  let  me  congratulate  you  on 
the  successful  manner  in  which  you  have  accom- 
plished your  object.  In  the  part  of  the  book  re- 
lating to  muscle  and  nerve,  and  to  physiology  of 
the  heart,  the  experiments  are  well  selected,  the 
methods  of  performing  them  carefully  indicated, 
and  therefore  the  student  himself  should  have  no 
difficulty  repeating  them.  In  the  latter  half  of  the 
book  the  experiments  seem  rather  difficult  to 
carry  out  by  students  in  classes,  owing  to  the  ap- 
paratus required  and  the  inherent  difficulty  of 
some  of  the  problems.  With  small  groups  and  an 
efficient  demonstrator,  they  will  prove  most  in- 
structive. I  hope  the  book  will  have  a  large  sale, 
and  thus  contribute  to  the  development  of  physio- 
logical science  along  practical  lines." 

Prof.  William  T.  Councilman,  Harvard  Uni- 
versity : 

"I  have  received  and  gone  over  your  Manual 
of  Physiology,  which  I  think  is  extremely  good." 

Prof.  J.  B.  Pawlow,  director  of  the  Imperial 
Russian  Institute  for  Military  Medicine,  St. 
Petersburg : 

"Highly  Honored  Colleague — I  bring  my  best 
thanks  for  the  kind  presentation  of  your  book, 
Manual  of  Physiology,  which  I  have  read  with 
great  interest.  The  working  out  of  a  normal  plan 
for  practical  demonstration  and  study  of  physi- 
ology is  the  most  important  object  of  the  present 
time,  and. in  which  you  have  succeeded." 

Professor  Pawlow  is  universally  acknowledged 
to  be  the  foremost  physiologist  of  the  day. 


Dr.  William  Wilhelm  Craven,  class  of  1903,  of 

Huntersville,  N.  C,  was  appointed  resident  physi- 
cian in  the  McKeesport  (Pa.)  Hospital  shortly 
after  graduation,  and  served  there  a  year,  then 
went  to  North  Carolina,  where  he  opened  an  office 
in  Huntersville.  Dr.  Craven  remained  in  Hun- 
tersville a  little  more  than  a  year,  and  had  a  most 
excellent  practice,  but  decided  to   give  it  up  to 


THE    HOSPITAL    BULLETIN 


155 


accept  a  position  as  physician  for  the  Carolina, 
Clinchfield  &  Ohio  Railway  Co.,  which  at  that 
time  was  extending  its  lines  through  the  moun- 
tains of  Western  North  Carolina.  He  served 
with  them  two  years,  then  returned  to  his  former 
location  in  Huntersville  and  again  took  up  his 
practice  there.  Dr.  W.  S.  Davidson,  class  of 
1887.  is  also  located  at  Huntersville. 


Dr.  George  C.  Battle,  class  of  19 12.  has  re- 
signed as  assistant  resident  physician  of  the 
Municipal  1  [ospital  for  Tuberculosis  because  of 
ill-health. 


Dr.  Dempsey  William  Snuffer,  class  of  1906, 
of  Becklev.  W.  Ya.,  has  been  appointed  president 
of  the  board  of  health  for  Raleigh  county,  West 
Virginia,  for  a  term  of  four  years  from  Septem- 
ber 1,  1912. 


Dr.  John  Turner,  Jr..  class  of  1892,  has  re- 
signed as  physician  to  the  city  employes  at  Loch 
Raven. 


Dr.  Ernest  Zueblin,  whose  opening  address  to 
his  students  is  published  elsewhere  in  this  issue, 
arrived  in  Baltimore  on  September  18  and  spent 
the  19th  in  the  University  Hospital  attending  to 
patients. 


Dr.  Calvin  Todd  Young,  class  of  1903,  of  Plant 
City,  Fla.,  was  a  delegate  from  Florida  to  the  In- 
ternational Congress  on  Demography,  held  in 
Washington  recently.  Dr.  Watson  Smith  Ran- 
kin, class  of  1901,  secretary  of  the  State  Board  of 
Health  of  North  Carolina,  was  also  a  delegate 
from  North  Carolina,  and  both  he  and  Dr.  Young 
availed  themselves  of  the  opportunity  to  slip  over 
from  Washington  to  visit  their  old  friends  at  the 
Universitv. 


Dr.  Howard  Steele  Holloway,  class  of  1903, 
formerly  assistant  resident  physician  at  the  Uni- 
versity Hospital,  has  located  at  Chattahoochee, 
Fla. 


The  sophomore  medical  class  has  elected  offi- 
cers for  the  coming  year  as  follows :  President, 
Mark'  V.  Ziegler  of  Maryland;  vice-president, 
Franklin  B.  Anderson  of  Maryland;  secretary, 
Michael  J.  Egan,  Jr.,  of  Georgia  ;  treasurer,  Bas- 
com  L.  Wilson  of  North  Carolina ;  sergeant-at- 


arms,  Lyle  Leeland  Gordy  of  Maryland,  and  his- 
torian, Dorsey  Paul  Etzler  of  Maryland.  The 
honor  committee  consists  of  John  Lowry  of  North 
Carolina,  Harry  Jesse  Gilbert  of  New  Jersey, 
Lyle  Leeland  Gordy  of  Maryland,  Louis  Diener 
of  Yirginia  and  Xevins  B.  Hendrix  of  South 
Carolina. 


Dr.  William  Michel,  class  of  1912,  will  hold  a 
German  class  during  the  coming  year  for  the  ben- 
efit of  the  resident  staff  of  the  University  Hos- 
pital. 


Among  the  recent  visitors  to  the  LTniversity 
Hospital  were : 

Dr.  Charles  E.  Terry,  class  of  1903,  of  Jack- 
sonville, Fla. 

Dr.  Norman  S.  Dudley,  class  of  1901,  of 
Church  Hill,  Md. 

Dr.  L.  M.  Allen,  class  of  1896,  of  Winches- 
ter, Ya. 

Dr.  J.  Ernest  Dowdy,  class  of  1909,  of  Win- 
ston-Salem, N.  C. 


Dr.  William  T.  Rowe.  class  of  1890,  of  Meyers- 
dale,  Pa.,  had  the  misfortune  to  be  thrown  from 
his  automobile  on  October  8  while  returning 
home  from  the  funeral  of  a  brother  physician — 
Dr.  John  S.  Garman.  Dr.  Rowe  turned  aside  to 
avoid  crashing  into  a  carriage  ahead  of  him  in 
which  were  attendants  at  the  funeral,  and  his  ma- 
chine plunged  over  an  eight-foot  embankment. 
He  was  severely  cut  about  the  face. 


The  Baltimore  Xezvs  of  September  25  gives 
rather  an  interesting  account  of  the  life  of  Dr. 
John  Samuel  Fulton,  class  of  188 1,  whose  work 
in  the  International  Congress  on  Tuberculosis 
and  the  International  Congress  on  Demography 
is  so  well  known.     Of  his  life  it  writes: 

"Though  born  in  Ohio  (in  Fremont,  in  1859), 
John  Samuel  Fulton  was  educated  in  Maryland, 
having  received  his  bachelor  of  arts  degree  from 
old  St.  John's  (1876)  and  his  doctor  of  medicine 
degree  from  the  University  of  Maryland.  He  is  a 
loyal  son  of  the  State  of  his  adoption,  a  fondness 
shown  first  of  all  by  his  marriage  with  a  Mary- 
land girl.  Miss  Nancy  White  of  Salisbury,  where 
he  practiced  as  a  young  man,  and  by  the  pride 
he  takes  in  his  Maryland  and  Baltimore  citizen- 
ship. It  is  said  that  he  never  misses  an  oppor- 
tunity to  register  and  vote,  and  keenly  feels  his 


i56 


THE    HOSPITAL    BULLETIN 


responsibility  in  all  matters  of  public  welfare. 
'A  good  citizen'  is  the  verdict  of  'those  who  are 
familiar  w  ith  the  man  and  his  work. 

"However,  his  manifold  duties  as  a  'public 
hygienist'  have  not  interfered  in  the  least  with 
his  responsibilities  as  a  father.  To  his  three  sons, 
the  eldest  of  whom  has  just  received  his  bachelor 
of  arts  degree  from  the  Hopkins,  he  is  said  to  be 
a  'boy  with  his  boys,'  enjoying  their  sports  and 
pleasures  with  the  same  zest  and  heartiness  as  if 
he  were  a  college  lad  himself,  lie  is  equally  de- 
voted to  his  daughters,  the  eldest  of  whom  grad- 
uates from  Goucher  this  coming  June.  The  sport 
he  is  most  fond  of  is  sailing.  In  fact,  it  is  said 
he  never  will  be  old,  because  he  always  sees 
the  happy  side  of  things  and  generously  makes 
allowance  for  shortcomings  of  the  'other  fel- 
low.' " 

The  News  goes  on,  and  in  writing  of  the  per- 
sonal qualities  of  Dr.  Fulton,  quotes  his  secretary 
as  follows : 

"He  is  the  kind  of  man  who  believes  in  giving 
every  fellow  his  chance.  He  looks  at  humanity 
not  merely  as  a  man,  but  as  a  collection  of  indi- 
viduals in  which  every  allowance  should  be  made 
for  everybody. 

"Maybe  I  could  best  illustrate  that  by  a  little 
incident  that  happened  the  other  day.  A  letter 
came  for  Dr.  Fulton  from  a  woman  way  off 
somewhere  and  containing  most  unreasonable 
requests.  Among  other  things  she  wanted  all  the 
literature  of  the  Congress  to  be  mailed  to  her  free 
of  charge,  as  she  had  not  the  money  to  pay  for 
it.  I  called  Dr.  Fulton's  attention  to  it,  but  in  the 
great  rush  of  our  work  put  it  aside,  intending  not 
to  bother  him  with  it  again  until  later.  The  very 
next  morning  he  asked  me  about  it  and  told  me 
to  be  sure  to  give  that  poor  woman  all  she  had 
asked  for. 

"As  a  Baltimorean  you  ought  to  know  that  he 
was  one  of  the  men  who  were  chiefly  responsible 
for  getting  up  the  big  tuberculosis  conference  in 
Baltimore  in  1904,  just  before  the  fire,  and  that 
for  years  he  was  the  secretary  of  the  Maryland 
State  Board  of  Health." 

And  The  News  showed  up  the  humanness  of 
the  man  by  asking  him  if  he  was  not  proud  and 
happy  over  his  work  in  Washington  and  receiving 
the  answer,  "Not  half  so  proud  as  I  am  of  that 
little  senior  of  mine  up  at  ( lonelier." 


Dr.  FitzRandolph  Winslow,  class  of  1900. 
served  as  superintendent  of  the  University  Hos- 
pital during  the  absence  of  Dr.  William  J.  Cole- 
man upon  his  vacation. 


Miss  Esther  E.  Brewington,  University  Hospi- 
tal Training  School  for  Nurses,  class  of  1907,  has 
been  appointed  assistant  to  Miss  Rosamond  Min- 
nis,  class  of  11)07,  m  the  James  Walker  Memorial 
Hospital  in  Wilmington,  Del. 


Dr.  Wallace  Sellman.  class  of  m;o3,  formerly 
of  Fairmont,  W.  Va.,  has  temporarily  discon- 
tinued the  practice  of  medicine. 


Miss  E.  Janie  Guerrant,  University  Hosptial 
Training  School  for  Nurses,  class  of  1904,  who 
was  operated  upon  recently  in  the  University 
Hospital  for  an  injury  to  her  knee,  is  doing  nicely. 


Dr.  George  M.  Settle  of  the  Neurological  De- 
partment has  returned  from  a  vacation,  which 
he  spent  in  Savannah  and  Jacksonville. 


Dr.  Gideon  M.  Van  Poole,  class  of  1899,  Major. 
Medical  Corps,  U.  S.  A.,  is  stationed  at  Fort 
Washington,  Md. 


The  sixth  full-time  man  to  be  appointed  in  the 
University  is  Dr.  Bert  Jacob  Asper,  class  of  191 1 . 
who  will  be  instructor  in  pharmacology  and  clin- 
ical microscopy. 


Dr.  Frank  Lynn,  class  of  1907,  who  has  been 
visiting  in  Ohio,  has  returned  home  and  resumed 
his  practice. 


The  University  building  has  been  completely 
renovated.  The  laboratories  which  were  built 
upon  the  surgical  ward  porch  have  been  opened. 
One  will  be  used  by  the  visiting  staff  for  special 
work  and  the  other  for  the  general  routine  work 
of  the  hospital.  A  new  steam  plant  has  been  in- 
stalled in  Davidge  Hall.  The  museum  has  been 
completely  overhauled  and  the  specimens  so  ar- 
ranged that  they  can  be  used  for  teaching  pur- 
poses. A  terrazzo  floor  has  been  laid  in  the  main 
hall  of  the  University  building.  The  old  mater- 
nity building  has  been  reconstructed  and  opened 
as  an  annex  to  the  dispensary,  and  will  be  used 
by  the  medical  department.     The  library  will  be 


THE    HOSPITAL    BULLETIN 


i.v 


Open  four  hours  daily,  from   12  to  4,  instead  of 
two  hours,  as  heretofore. 


Dr.   Thomas    Henry   Legg,   class   of    1907,   of 
Union  Bridge,   Md.,  was  a  recent  visitor  to  the 

I   Diversity  I  lospilal. 


Tampa — Lester  Julian  Efird,  class  of  1903,  405 
[Boulevard ;  Rollin  Jefferson,  class  of  1903,  609 >4 
franklin  street;  J.  Brown  Wallace,  class  of  1897, 
1  >;>'_•  Franklin  street. 


Dr.  Morris  R.  Bowie,  class  of  1908,  of  Somer- 
set, Colo.,  who  has  been  spending  the  summer  in 
Scotland,  is  the  guest  of  Dr.  Albert  Hyson  Car- 
roll, class  of  1907,  for  a  few  days 


Among  the  University  alumni  practicing  in 
Florida  are: 

Tionifay — R.  S.  Maneely,  class  of  1904. 

Citra — Robert  Lawson  Kennedy,  class  of  19 1.0. 

Daytona — James  E.  Rawlings,  class  of  1904. 

Jacksonville — Samuel  Gilman  Glover,  class  of 
1910,  resident  physician  St.  Luke's  Hospital; 
Howard  S.  Holloway,  class  of  1903,  Bay  and 
Laura  streets;  Franklin  Pierce  Hoover,  class  of 
1884,  Mutual  Life  Building;  Chas.  L.  Jennings, 
class  of  1906,  332  W.  Monroe  street ;  Claude  Joy- 
ner,  class  of  1888,  400  W.  Ashley  street ;  John 
Hartridge  Livingston,  class  of  1878,  304  Newman 
street;  Jas.  D.  Love,  class  of  1897,  501  Laura 
street;  Robert  Lee  May.  class  of  1890,  17  W. 
Beaver  street ;  Robert  H.  McGinnis,  class  of  1897, 
501  Laura  street;  J.  Denham  Palmer,  class  of 
(872,  Doty  Building;  James  It.  Parramore,  class 
of  1909,  412  E.  Monroe  street;  Louis  Stinson, 
class  of  191 1,  107  Ocean  street;  Charles  Edward 
Terry,  class  of  1903,  City  Hall;  Fred.  J.  Waas, 
class  of  1905,  108  W.  Adams  street;  George  Wal- 
ter, class  of  1910,  131  W.  Adams  street. 

Lake  City — Abner  J.  P.  Julian,  class  of  1883. 

Lakeland — Cicero  W.  Love,  class  of  1902. 

Lake  Weir — Hugh  W.  Henry,  Jr.,  class  of  189T. 

Lawtey — George  W.  Brown,  class  of  1889. 

Mcintosh — Adam  Clark  Walkup,  class  of  1909. 

New  Smyrna — William  C.  Chowning,  class  of 
1904. 

Ocala — Arthur  L.  Liar,  class  of  1889. 

1  )rlando — Sylvan  McElroy,  class  of  1907. 

Plant  City — Calvin  T.  Young,  class  of  1903. 

Ouincy — Clyde  C.  Mack,  class  of  1904. 

Sanford — Oscar  Wcntworth  King,  class  of 
1007;  Samuel  Puleston,  class  of  1902. 

Tallahassee — Benjamin  J.  Bond,  class  of  1904; 
Fred  Clifton  Moore,  class  of  1003  ;  Henry  Ed- 
wards Palmer,  class  of   1892. 


Dr.  John  Rawson  Pennington,  class  of  1887,  of 
4620  Kenmore  avenue,  Chicago,  111.,  presented  a 
paper  on  the  X-rays  as  an  Aid  in  making  Diag- 
nosis of  Conditions  in  the  Rectum  and  Other 
Portions  of  the  Large  Intestine  at  the  fourteenth 
annual  meeting  of  the  American  Proctologic  So- 
ciety, held  in  Atlantic  City,  N.  J.,  June  3  and  4, 
1 912.  Dr.  Pennington  stated  that  "while  the  rec- 
tum is  easily  inspected  by  various  specula,  and 
the  sigmoid  is  less  readily  accessible  by  the  use  of 
sigmoidoscopes,  such  as  the  one  with  insufflation 
devised  by  him,  the  colon  is  inaccessible  and  its 
exact  position  difficult  to  ascertain.  Very  often 
it  is  also  difficult  to  determine  and  locate  patho- 
logic conditions  in  the  large  intestine. 

"Until  recently  the  means  of  diagnosis  have 
been  limited  to  those  used  in  other  portions  of  the 
alimentary  canal,  viz.,  inspection  after  dilatation 
of  the  bowel  with  air  or  water,  palpation,  percus- 
sion and  trans-illumination.  All  of  these  are 
open  to  the  objection  that  they  are  uncertain. 

"The  writer  observed  in  the  latter  part  of  1899 
that  by  introducing  some  agent  into  the  large 
bowel  which  would  cast  a  shadow,  the  X-rays 
may  become  useful  in  making  a  diagnosis  of  con- 
ditions in  the  twin  cavities.  It  is  only  recently, 
ho\ve\  er.  that  such  procedures  have  become  of 
practical  value. 

"A  bismuth  meal  is  useful  in  diseases  of  the 
stomach  or  duodenum,  the  agent  being  suspended 
in  milk,  acacia  water,  thick  soup  or  some  similar 
vehicle. 

"But  for  the  large  bowel  the  action  of  bismuth 
per  os  is  very  slow.  One  author  estimates  that  it 
requires  from  12  to  15  hours  for  the  bismuth  mix- 
ture to  reach  the  ileo-cecal  valve ;  about  24  hours 
to  gain  the  transverse  colon,  and  36  hours  to  pene- 
trate to  the  sigmoid.  By  the  method  advocated 
this  is  done,  so  to  speak,  instantaneously. 

"Coming  now  to  the  technic :  The  patient's 
bowels  are  first  cleansed  by  means  of  laxatives 
and  injections.  He  is  then  placed  in  the  knee- 
shoulder  position,  and  from  25  to  30  ounces  of  the 
mixture  used  for  casting  the  shadow  injected  into 
the  large  intestine.  For  this  purpose  the  author 
uses  an  ordinary  irrigator  and  a  short  rectal  tip. 


158 


THE    HOSPITAL    BULLETIN 


A  long  rectal  or  colonic  tube  for  administering  the 
injection  is  unnecessary.  After  the  suspension  is 
injected  the  patient  lies  on  his  right  side  for  a  few 
moments  so  part  of  the  menstrum  may  pass  into 
the  cecum.  He  is  then  placed  in  either  dorsal  or 
ventral  position  on  the  radiographic  table  and  the 
picture  taken." 

Dr.  Pennington  is  one  of  the  best  known  of 
the  University  alumni.  He  takes  a  most  promi- 
nent part  in  the  work  and  meetings  of  the  Ameri- 
can Proctologic  Society.  He  occupies  the  chair 
of  rectal  diseases  in  the  Chicago  Polyclinic  and 
Hospital. 


Among  the  University  alumni  practicing  in 
Illinois  are: 

Cairo — Henry  W.  YVickes,  class  of  1892,  Sur- 
geon U.  S.  P.  H.  and  M.  H.  S. 

Charleston — Christopher  C.  Webb,  class  of 
1 881. 

Chicago— Philip  Adolphus,  class  of  1858,  1639 
Washington  Boulevard ;  Metellus  R.  Barclay, 
class  of  1889,  838  N.  Clark  street;  Perry  L. 
Boyer,  class  of  1899,  Captain  M.  C,  U.  S.  A., 
Federal  Building;  John  H.  Chew,  class  of  1863, 
1223  Astor  street;  Daniel  David  Coffey,  class  of 
1903,  1347  Noble  street;  Lawrence  De  Lancy 
Gorgas,  class  of  1883,  1504  E.  57th  street;  Louis 
M.  Maus,  class  of  1874,  Colonel  M.  C,  U.  S.  A., 
Central  Division;  Chas.  W.  Morrow,  class  of 
1887,  6334  Monroe  street;  John  Rawson  Pen- 
nington, class  of  1887,  31  N.  State  street;  David 
Salinger,  class  of  1894,  31  N.  State  street;  Oliver 
Tydings,  class  of  1877,  31  N.  State  street;  An- 
thony Kimmel  Warner,  class  of  1885,  1024  Bel- 
mont avenue;  George  Young,  class  of  1887,  Sur- 
geon U.  S.  P.  H.  and  M.  H.  S.,  City  Hall. 

Collinsville — Lay  Gordon  Burroughs,  class  of 
1906. 

Fort  Sheridan — Gideon  McD.  Van  Poole,  class 
of  1899,  Major  M.  C,  U.  S.  A. 

Grand  Tower — William  Robert  Gardinar,  class 
of  1910. 

Peoria — Leonard  H.  Spalding,  class  of  1869, 
805  N.  Jefferson  avenue. 

Sullivan — Geo.  Brinton  Kessler,  class  of  1890. 


A  portrait  of  Dr.  James  H.  Jarrett,  class  of 
1852,  of  Towson,  Md.,  will  be  on  exhibition  at 
the   meeting:   of   the   Baltimore    County    Medical 


Association,  October  16,  1912.  Dr.  William  J. 
Todd  will  read  a  sketch  of  Dr.  Jarrett's  life,  and 
the  picture  will  be  later  presented  to  the  Medical 
and  Chirurgical  Faculty  of  Maryland.  Dr.  Jar- 
rett has  practiced  in  Maryland  for  fifty  years. 


Dr.  Lewis  Mines  Allen,  class  of  1896,  of  Win- 
chester, Ya.,  was  elected  secretary-treasurer  of 
the  Shenandoah  Valley  Medical  Society  at  Har- 
risonburg, Ya. 


Dr.  Ernest  Seth  Bulluck.  class  of  1911,  of  Wil- 
mington, N.  C,  has  been  taking  a  post-graduate 
course  in  New  York. 


Mr.  Howard  E.  Lecates  of  the  Senior  Class, 
who  recently  underwent  an  operation  on  the  neck, 
is  recuperating  at  his  home  in  Delaware. 


Dr.  Melchoir  Gist  Cockey,  class  of  1879,  °f 
Salina.  Kansas,  was  a  recent  visitor  to  Baltimore 
and  to  his  former  home  in  Cockevsville,  Md. 


Dr.  Lawrence  E.  McDaniel,  class  of  191 1,  has 
been  appointed  resident  physician  to  Blue  Moun- 
tain House,  Pen  Mar.  Md. 


Among  the  recent  visitors  to  the  University 
Hospital  was  Dr.  Thomas  Malcolm  Bizzell,  class 
of  1908,  of  Goldsboro,  N.  C. 


The  class  of  1908  of  the  Medical  School  will 
hold  a  reunion  in  Baltimore  in  May,  1913. 


Miss  Mary  Louise  Gephart.  University  Hospi- 
tal Training  School  for  Nurses,  class  of  191 1,  has 
resigned  as  superintendent  of  the  Havre  de  Grace 
Hospital  and  has  resumed  private  work. 


Dr.  William  Tumor  W'ooton,  class  of  1890.  of 
Hot  Springs,  Ark.,  was  elected  president  of  the 
Medical  Association  of  the  Southwest  at  the  meet- 
ing held  in  Hot  Springs,  Ark.,  on  October  10, 
19 12.  Dr.  Wooton  has  an  office  in  the  Dugan- 
Stuart  Building  in  Hot  Springs.  The  Medical 
Society  of  the  Southwest  was  organized  in  1905, 
and  its  membership  is  limited  to  members  of  the 
State  societies  of  Arkansas,  Missouri,  Texas, 
Kansas  and   Oklahoma.     The  next  meeting,   at 


THE    HOSPITAL    BULLETIN 


159 


which   Dr.   Wooton  will  preside,  will  he  held   in 
Kansas  City  in  1913. 


Dr.  William  Cuthbert  Lyon,  class  of  1907,  has 
(1. mated  a  chloroform  bottle  to  the  operating- 
room. 


We  are  glad  to  announce  that  Dr.  Joseph  E. 
( iichner.  class  of  1890,  who  recently  suffered  a 
painful  injury  to  his  foot,  necessitating  amputa- 
tion of  a  toe,  has  sufficiently  recovered  to  resume 
his  work.  The  injury  was  incurred  on  a  motor- 
boat. 


Dr.  llyman  R.  Wiener,  class  of  1912,  of  the 
Harrisburg  Hospital,  was  a  recent  visitor  in  Bal- 
timore, and  took  occasion  while  here  to  look  up 
his  old  friends  at  the  University  Hospital. 


Miss  May  Katherine  Steiner,  University  Hos- 
pital Training  School  for  Nurses,  class  of  1912, 
has  been  appointed  assistant  superintendent  of  the 
Annapolis  Emergency  Hospital.  Miss  Alice 
Frances  Bell,  class  of  1907.  is  superintendent. 


In  reply  to  the  letter  of  an  alumnus,  we  beg  to 
state  that  Dr.  Howard  T.  Robinson,  class  of  1904, 
is  located  at  Grantsville,  Garret  county,  Md. ; 
Dr.  Oscar  Wentworth  King,  class  of  1907,  is  at 
San  ford.  Orange  county,  Fla.,  and  Dr.  Claude  J. 
B.  Flowers,  class  of  1907,  is  at  1609  Market 
street,  Harrisburg,  Pa. 


MARRIAGES 

Dr.  George  Wilmer  Yourtree.  class  of  1902, 
of  Burkittsville,  Md.,  was  married  to  Miss  Laura 
Eleanor  Hightman  in  St.  Luke's  Lutheran 
Church,  Burkittsville,  Md.,  on  September  25, 
1912,  by  Rev.  Charles  J.  Hines.  Miss  Elizabeth 
Hightman  was  maid  of  honor,  and  Howard 
Yourtree.  brother  of  the  groom,  was  best  man. 
Dr.  11.  W.  Gray  of  Washington  was  an  usher, 
and  Misses  Evelyn  Yourtree  and  Ruth  Shafer 
were  flower  girls.  After  a  trip  to  Bermuda  the 
couple  will  live  at  Burkittsville,  where  the  groom 
has  built  up  an  extensive  practice. 


Dr.  Howard  J.  Maldeis,  class  of  1903,  was  mar- 
ried to  Miss  Louise  Cecil  Watkins,  a  member  of 
the  1913  class  of  the  University  Hospital  Train- 
ing School  for  Nurses  on  Saturday,  September 
7,  1912.  at   11.30  A.  M.  at  the  residence  of  the 


bride's  father,  Mr.  W.  Maurice  Watkins,  Kate 
avenue,  Arlington.  Rev.  E.  M.  Heffer,  pastor  of 
Arlington  Methodist  Episcopal  Church,  officiated. 
The  couple  spent  a  honeymoon  in  the  North,  and 
returned  in  time  for  Dr.  Maldeis  to  take  up  his 
duties  at  the  University.  They  will  reside  on 
Kate  avenue,  Arlington,  Md. 


Dr.  James  Hugh  Bay,  class  of  1908,  of  Havre 
de  Grace,  Md.,  was  married  to  Miss  Mary  Barton 
Saulsburv,  University  Hospital  Training  School 
for  Nurses,  class  of  1909,  on  Tuesday,  September 
10,  1912,  at  4  o'clock,  at  the  home  of  the  bride's 
sister,  Mrs.  William  G.  Pugh,  Govans,  Md.  Miss 
Saulsbury  is  a  daughter  of  the  late  Dr.  and  Mrs. 
Thomas  Bascom  Saulsbury  of  the  Eastern  Shore. 
She  was  formerly  superintendent  of  the  training 
school  of  the  Maryland  Homeopathic  Hospital  of 
Baltimore.  Dr.  Bay  is  the  son  of  Mr.  and  Mrs. 
Thomas  A.  Bay  of  Jarrettsville,  Md. 

The  ceremony  was  performed  by  Rev.  Dr.  Mc- 
Millan, pastor  of  the  Govans  Presbyterian 
Church,  and  was  witnessed  only  by  a  few  relatives 
and  close  friends  of  the  couple.  The  parlor  was 
beautifully  decorated  with  golden  rod  and  ferns. 
The  bride  wore  a  traveling  suit  of  brown,  with 
hat  and  gloves  to  match.  A  reception  was  ten- 
dered Dr.  and  Mrs.  Bay  immediately  after  the 
ceremony,  and  at  6  o'clock  they  boarded  the  Mer- 
chants &  Miner's  Line  for  a  trip  to  Boston.  They 
also  visited  Niagara  and  returned  home  via  the 
Hudson.    They  will  reside  in  Havre  de  Grace. 


BIRTHS 

A  son  has  been  born  to  Dr.  Dwight  Gray 
Rivers,  class  of  1910,  of  Fort  White,  Fla.,  and 
Mrs.  Rivers,  formerly  Miss  Martha  Yenable 
Edmunds,  University  Hospital  Training  School 
for  Nurses,  class  of  1910. 


Dr.  Emile  Bonniwell  Quillen,  class  of  1904.  of 
Rocky  Mount,  N.  C,  and  Mrs.  Quillen,  formerly 
Miss  Leila  Griffith  Owings,  L'niversity  Hospital 
Training  School  for  Nurses,  class  of  1905,  have 
announced  the  birth  of  a  daughter. 


DEATHS 


It  is  with  much  regret  that  we  announce  the 
death  of  Mrs.  Georgie  Davis  Knipp,  wife  of  Dr. 
Harry  Edward  Knipp,  class  of  1887,  of  1002  West 


l()0 


THE    HOSPITAL    BULLETIN 


Lanvale  street,  Baltimore,  on  October  14,  1912, 
of  tuberculosis.  Mrs.  Knipp  was  the  daughter  of 
George  H.  Davis  of  Carroll  county,  and  although 
there  were  three  sons  in  the  family,  she  bore  her 
father's  full  name  until  her  marriage.  She  was  a 
graduate  of  the  State  Normal  School,  and  taught 
for  some  years  in  Carroll  and  Baltimore  counties. 
She  was  married  to  Dr.  Knipp  seventeen  years 
ago,  and  was  all  of  her  life  a  great  church  worker. 
She  is  survived  by  her  husband  and  a  daughter. 
Miss  Minna  Knipp,  and  a  son,  George  Adam 
Knipp,  three  brothers  and  four  sisters.  One  of 
the  brothers  surviving  is  Dr.  Charles  R.  Davis, 
class  of  1890,  of  923  North  Carrollton  avenue. 


Dr.  Robert  Morris  Dawson,  class  of  1869,  died 
at  his  home  at  Bay  Hundred,  Talbot  county,  Md., 
September  8,  1912,  aged  73  years.  He  is  sur- 
vived by  his  wife.  Dr.  Dawson  was  born  March 
12,  1839,  at  Royal  Oak,  Talbot  county,  Md.,  the 
son  of  Major  John  Dawson.  He  was  educated  at 
the  Maryland  Military  Academy  and  Fort  Ed- 
ward Institute,  New  York,  and  served  in  the  Sec- 
ond Maryland  Cavalry,  C.  S.  A.  After  the  war 
he  entered  the  office  of  Dr.  W.  G.  G.  Willson  of 
Easton,  Md.,  and  later  matriculated  at  the  Uni- 
versity of  Maryland,  graduating  in  1869.  He 
practiced  at  Royal  Oak  for  eight  years,  and  later 
moved  to  Bay  Hundred,  where  he  continued  his 
practice  until  recently.  Dr.  Dawson  was  also 
much  interested  in  agriculture  and  owned  a  large 
farm  which  he  personally  conducted. 


Dr.  James  H.  Butler,  class  of  1857,  died  at  his 
home,  1507  Bolton  street,  on  September  26,  1912, 
of  apoplexy.  Dr.  Butler  had  not  been  well  for 
several  weeks  prior  to  his  death,  but  he  spent  part 
of  each  day  in  his  office  in  the  custom-house,  and 
went  as  usual  on  the  day  of  his  death.  He  re- 
turned to  his  home  for  lunch  about  noon,  and 
complained  of  not  feeling  well.  He  suffered  the 
attack  shortly  after  reaching  his  home,  and  a  phy- 
sician who  was  summoned  said  he  died  soon  after 
having  the  stroke.  Dr.  Butler  was  born  in  Balti- 
more in  1836,  and  when  quite  young  became  asso- 
ciated with  the  banking-house  of  Samuel  Win- 
chester at  Baltimore  and  North  streets,  later  be- 
ginning the  study  of  medicine  in  the  office  of  the 
late  Dr.  Geo.  W.  Miltenberger.  He  entered  the 
University  and  was  graduated  in  1857,  and  ap- 
pointed resident  physician  of  the  University  Hos- 


pital, then  the  Baltimore  Infirmary.  At  the  death 
of  Dr.  Berwick  B.  Smith,  demonstrator  of  anatomy 
at  the  University,  Dr.  Butler  assumed  his  duties. 
During  the  Civil  War  he  served  as  a  surgeon  in 
charge  of  the  United  States  Army  Hospital  in 
Baltimore.  In  1876  he  ran  for  Congress,  but  was 
defeated  by  Thomas  Swann.  He  then  entered 
the  customs  service  (1877),  and  was  made  exam- 
iner of  drugs,  holding  that  position  until  1892, 
when  President  Harrison  made  him  an  appraiser 
at  Baltimore.  At  the  time  of  his  death  he  was,  in 
point  of  service,  the  oldest  appraiser  in  the  ser- 
vice. Dr.  Butler  was  an  active  member  of  Asso- 
ciate Congregational  Church,  a  member  of  Ori- 
ental Lodge  of  Masons  and  Beauseant  Com- 
mandery  of  Knights  Templar,  and  was  a  member 
of  the  board  of  managers  of  the  Masonic  Temple. 
He  is  survived  by  one  daughter,  Miss  Mabel 
Butler,  his  wife,  formerly  Miss  Kate  Griffis,  hav- 
ing died  four  years  ago.  He  was  buried  from  his 
home  on  Monday,  September  30,  services  at  the 
cemetery  being  conducted  by  Oriental  Lodge  of 
Masons.  The  honorary  pallbearers  were  Gen. 
Thomas  J.  Shryock,  John  M.  Carter,  C.  C.  Isaacs, 
A.  H.  Fetting,  William  D.  Waxter,  Charles  C. 
Homer,  Jr.,  Harry  A.  Remley,  George  F.  M. 
Hauck,  Dr.  Walter  B.  Piatt,  P.  E.  Tome,  George 
Cook,  William  F.  Stone,  F.  Holmes  Hack,  J.  Car- 
lisle Wilmer,  J.  J.  Bell  and  John  Straughn. 
A  local  paper  writes  of  Dr.  Butler: 
"Dr.  James  H.  Butler,  for  35  years  connected 
with  the  United  States  Treasury  Department, 
was  buried  in  Baltimore  last  week  with  high 
Masonic  honors.  President  Carter  of  the  Vet- 
eran Association,  of  which  he  was  a  member, 
describes  him  as  a  man  whose  whole  life,  profes- 
sional, official,  as  churchman,  husband,  father. 
Mason  and  friend,  was  one  to  be  admired  and 
emulated,  and  adds :  'As  we  journey  along  the 
highway  of  life  we  are  often  reminded  of  the 
casualties  of  battle.  A  moment  ago  we  touched 
elbows  with  a  companion  and  friend;  noting  the 
failure  of  contact  and  we  turn  to  ascertain  the 
cause.  He  has  fallen,  and  the  silent  comrade  at 
our  side  mutually  affirms  the  lesson — in  the  midst 
of  life  we  are  in  death.'  " 


On  September  30,  1912,  Dorothy  Whiting,  in- 
fant daughter  of  Dr.  John  William  Ebert,  class 
of  1912.  and  Mrs.  Ebert.  Burial  was  in  Win- 
chester, .Ya. 


THE  HOSPITAL  BULLETIN 

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Entered  at  the  Baltimore  Post-office 
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Vol.  VIII 


BALTIMORE,  MD.,  NOVEMBER  15,   1912 


No.  9 


A   SUMMER  CRUISE  ON  THE  SPANISH 
MAIN. 


By  Ran .ph  Winslow,  M.D. 


3.     The  Panama  Canal. 

Almost  from  the  time  that  Balboa  climbed  the 
hill  on  the  Isthmus  of  Panama  and  saw  both  the 
seas,  separated  by  only  a  few  miles  of  land,  the 
conception  of  uniting  the  Atlantic  and  Pacific  by 
means  of  an  artificial  waterway  was  entertained. 
Numerous  suggestions  were  made  by  different 
persons  at  an  early  period.  Angel  Saavedra  pro- 
posed to  pierce  the  Isthmus  of  Darien  in  1520, 
and  Antonio  Galvao  suggested  a  canal  across 
Panama  in  1550.  Simon  Bolivar,  President  of 
Columbia,  caused  a  crude  survey  of  the  Isthmus 
to  be  made  in  1830,  and  the  United  States  Gov- 
ernment made  complete  surveys  of  the  Panama 
and  Nicaragua  routes  in  1872-1875.  The  vision 
was  clear,  but  the  time  of  its  accomplishment 
was  still  far  in  the  future.  While  the  United 
States  was  negotiating  with  Columbia  for  per- 
mission to  build  the  canal,  the  latter  country 
awarded  the  franchise  to  a  French  company 
which,  under  the  leadership  of  the  distinguished 
de  Lesseps,  began  work  on  a  sea  level  canal  in 
1 88 1.  It  was  soon  discovered  that  a  sea  level 
canal  was  not  practicable  and  later  the  specifica- 
tions for  a  lock  canal  were  substituted.  After 
the  expenditure  of  a  vast  sum  of  money  and  the 
sacrifice  of  thousands  of  lives,  the  work  was  dis- 
continued for  lack  of  funds  in  1889.  In  1894  a 
new  French  company  obtained  a  concession  for 
10  years,  and  work  was  continued  in  a  desultory 
manner.  The  plans  of  the  French  engineers 
called  for  a  canal  75  feet  wide  and  16  feet  deep, 
and  they  actually  completed  some  15  miles  of 
excavating  at  sea  level,  but  made  but  little  im- 
pression on  the  elevated  and  more  difficult  por- 
tions of  the  work.     The  French*  failed  partly  for 


lack  of  efficient  machinery,  but  chiefly  on  account 
of  the  pestilential  diseases  that  caused  a  holo- 
caust among  their  employes.  The  time  for  the 
completion  of  the  canal,  however,  drew  on 
apace,  impelled  by  unexpected  and  irresistible 
events.  As  the  discovery  of  gold  in  California 
was  the  direct  cause  of  the  building  of  the  Pana- 
ma Railroad,  so  the  Spanish  War  is  the  imme- 
diate factor  in  the  completion  of  the  canal  by 
the  United  States.  The  record-breaking  voyage 
of  the  battleship  Texas  from  San  Francisco  to 
Cuba  during  the  Spanish-American  War  will  be 
readily  recalled,  and  this  showed  the  necessity  of 
a  shorter  means  of  transferring  our  warships 
from  one  coast  to  the  other.  The  feverish  haste 
in  completing  the  waterway  is  due  to  the  urgency 
of  preparing  for  the  national  defense,  rather 
than  to  the  advisibility  of  seeking  new  and 
shorter  commercial  trade  routes.  From  both 
defensive  and  commercial  aspects,  however,  the 
completion  of  the  canal  is  a  matter  of  the  great- 
est importance.  The  canal  will  be  about  50  miles 
in  length  from  deep  water  to  deep  water.  Begin- 
ning about  three  miles  from  shore  a  channel  has 
been  dredged  500  feet  wide  and  41  feet  deep, 
and,  discarding  the  completed  French  canal  en- 
tirely, a  new  canal  has  been  excavated,  of  the 
width  and  depth  mentioned,  to  Gatun.  The  total 
length  of  the  sea  level  portion  of  the  canal  on 
the  Atlantic  side  is  about  7  miles.  At  Gatun 
the  great  dam  is  thrown  across  the  Chagres  Val- 
ley, nearly  il/>  miles  in  length  and  y2  mile  in 
width  at  its  base,  and  rising  to  a  height  of  115 
feet  above  mean  sea  level.  This  dam  impounds 
the  waters  of  the  Chagres  River  and  converts 
an  area  of  swamp  and  jungle  into  a  lake  164 
square  miles  in  extent,  with  a  depth  of  85  feet. 
Ships  approaching  from  the  Caribbean  are  raised 
from  sea  level  to  the  Gatuh  Lake  85  feet  by 
means  of  three  huge  double  locks,  each  1,000  feet 
in  length  and  no  feet  wide,  and  as  tall  as  a  six- 
story  warehouse.     The  locks  are  constructed  of 


1 62 


THE    HOSPITAL    BULLETIN 


solid  concrete,  with  a  central  wall  dividing  them 
into  pairs.  In  both  the  middle  and  side  walls  are 
huge  culverts  as  large  as  a  railroad  tunnel, 
through  which  water  is  allowed  to  flow  into  the 
lock  chambers  and  to  fill  them  gradually  and 
quickly  without  the  disturbance  that  would  occur 
if  they  were  filled  by  allowing  water  to  rush  in 
from  the  end.  It  will  probably  take  about  15 
minutes  to  fill  or  empty  each  lock.  The  locks 
are  closed  by  great  steel  gates  7  feet  thick,  65 
feet  wide  and  from  47  to  82  feet  high.  Inter- 
mediate gates  are  also  placed  in  the  locks  in  or- 
der to  save  time  and  water  when  small  vessels 
are  being  passed  through.'  There  are  also  emer- 
gency contrivances  to  take  the  place  of  the  usual 


sage  of  the  largest  ships.  In  order  to  prevent 
too  great  a  pressure  of  water,  a  spillway  has 
been  constructed,  by  means  of  which  the  excess 
of  water  may  be  allowed  to  escape.  The  lake 
extends  from  Gatun  to  Bas  Obispo,  a  distance  of 
24  miles,  with  a  channel  varying  from  1000  to 
500  feet  and  a  depth  from  85  to  45  feet.  At 
Has  Obispo  the  great  Culebra  cut  begins,  and  ex- 
tends 9  miles  across  the  backbone  of  the  Isthmus. 
This  is  the  most  difficult  piece  of  engineering  of 
the  construction,  as  the  crest  of  the  hills  had 
to  be  cut  down  from  about  500  feet  to  85  feet. 
The  canal  prison  in  this  section  has  a  bottom 
width  of  300  feet  and  a  length  of  9  miles.  The 
Culebra  cut  at  its  widest  point  is  nearly  x/2  mile 


WEST    CHAMBER     LOOKING    MIRTH    PEDRO    MIGUEL    LOCKS.    PANAMA. 


gates  in  case  of  any  accident  to  the  latter.  Ships 
will  not  be  allowed  to  enter  the  locks  under  their 
own  steam,  but  will  be  drawn  through  by  electric 
locomotives  in  order  to  prevent  accidents.  Be- 
sides the  Gatun  locks,  there  are  two  others  at 
Pedro  Miguel  and  Miraflores,  the  former  con- 
sisting of  but  a  single  pair  and  the  latter  of  a 
double  pair  of  chambers.  Their  construction  and 
dimensions  are  similar  to  those  at  Gatun,  and  by 
their  means  ships  are  lowered  on  the  Pacific 
side.  The  water  for  the  canal  is  obtained  from 
the  Chagres  River,  which,  during  the  dry  season, 
is  an  insignificant  stream,  but  in  the  wet  season 
is  a  raging  torrent.  By  means  of  the  dam  at 
( iatun  the  waters  of  this  river  are  impounded 
into  a  lake  already  mentioned,  which  will  furnish 
at  all  times  a  sufficient  depth  to  permit  the  pas- 


across.  The  soil  and  rocks  seem  to  have  but 
small  cohesive  properties  here,  and  landslides 
are  constantly  taking  place  which  cause  much 
extra  labor  for  their  removal,  and  delay  the  open- 
ing of  the  canal.  Since  my  visit,  in  July,  several 
slides  have  occurred.  In  order  to  overcome  this 
tendency  to  slide,  the  hill  on  both  sides  is  being 
cut  back  on  terraces  at  different  levels,  causing 
an  appearance  like  gigantic  steps.  I  was  able  to 
ride  the  whole  length  of  the  Culebra  cut  in  a 
private  railroad  motor  car  and  to  get  an  accurate 
idea  of  the  magnitude  of  the  work,  and  to  see 
the  great  steam  shovels  scooping  out  the  sides 
of  the  hill,  and  the  compressed  air  drills  making 
holes  in  the  rocks ;  while  now  and  then  ex- 
plosions of  dynamite  would  cause  the  earth  to 
tremble  and  gave  an  impression  of  an  artillery 


THE    HOSPITAL    BULLETIN 


163 


engagement.  The  long  trains  of  dirt  cars  were 
constantly  coming  and  going,  removing  the  debris 
to  dumps,  where  low  places  were  being  filled  in. 
or  to  Balboa,  where  the  great  causeway  is  being 
constructed  between  the  mainland  and  the  islands 
in  the  bay.  The  high  level  section  of  the 
canal  ends  at  Pedro  Miguel,  where  there  is  a 
dam  and  locks  that  lower  ships  30  feet  to  the 
level  of  another  artificial  lake  \l/i  miles  in  length. 
The  Mirarlores  locks,  in  two  pairs,  lower  ships 
55  feet  to  the  Pacific  sea  level  section  of  the 
canal,  which  is  about  8  miles  in  length  and  ter- 
minates at  deep  water  in  the  bay.  l'alboa  is  the 
Pacific  entrance  to  the  canal,  as  Colon  is  its  At- 
lantic port.      The  tide  on  the  Pacific  side  varies 


saving  of  9540  miles.  In  like  manner,  the  dis- 
tance from  our  east  coast  to  points  on  the  west 
coast  of  South  America,  Japan,  China  and  the 
Philippines  will  be  lessened  by  thousands  of 
miles.  While  at  Colon  a  large  party  from  our 
ship  took  a  launch  up  the  canal  to  Gatun.  The 
water  in  the  harbor  was  rough  and  in  the  trough 
of  the  waves  the  boat  would  sink  so  low  that 
nothing  but  the  sky  and  sea  could  be  seen,  and 
this  was  on  a  clear,  calm  day.  Going  up  the 
new  American  canal  we  turned  into  the  French 
canal  and  passed  up  that  waterway  to  the  great 
dam.  The  French  canal  is  not  used,  except  to 
bring  supplies  to  Gatun.  Along  the  banks  of 
this   canal   is   an   enormous   amount   of   cast-oft 


CULEBRA    CUT    LOOKING    SOUTH. 


about  20  feet  daily,  while  on  the  Atlantic  side 
there  is  only  from  1  to  2  feet  variation,  hence 
it  will  be  much  more  difficult  to  maintain  the 
necessary  depth  in  the  Pacific  section  than  in  the 
other  sections.  I  have  briefly  described  the 
canal  from  Colon  to  Panama,  but  have  omitted 
any  reference  to  the  number  of  cubic  yards  of 
excavation  or  of  the  number  of  barrels  of  con- 
crete used  in  the  construction  of  the  locks  and 
dams  as  being  too  vast  for  the  comprehension  of 
the  lay  mind.  It  is  supposed  that  the  first  ship 
will  pass  through  the  canal  about  a  year  from 
now,  though  it  will  not  be  opened  officially  until 
a  later  period.  The  time  of  passage  through  the 
canal  will  be  from  8  to  10  hours.  From  Xew 
York  to  San  Francisco,  via  Cape  Horn,  is  14,840 
miles ;  via  the  canal  the  distance  is  5300  miles,  a 


machinery,  dredges,  steamboats  and  junk  which 
is  rusting  and  rotting  and  not  worth  breaking 
up  and  selling  for  old  iron.  Reaching  Gatun,  we 
viewed  the  locks,  and  then  walked  a  mile  along 
the  crest  of  the  dam  to  the  spillway;  the  heat 
was  not  oppressive,  though  the  humidity  was 
unpleasant.  There  were  over  30  feet  of  water  in 
the  lake,  but  it  was  interfering  with  work  on 
the  locks,  so  the  spillway  was  open  and  the  water 
was  escaping.  When  the  lake  is  filled,  the  sites 
of  many  of  the  towns  along  the  canal  will  be 
covered  with  water,  such  as  Gorgona,  the  seat 
of  the  immense  machine  shops;  Matachin,  and 
many  others.  The  railroad  formerly  was  located 
in  the  bed  of  the  lake,  but  it  has  been  recon- 
structed upon  higher  ground  well  above  the 
level  of  the  lake.     Upon  the  completion  of  the 


i64 


THE    HOSPITAL    BULLETIN 


AERO  VIEW  OF  THE  TANAMA  CANAL. 


canal  it  is  the  intention  of  the  commissioners  to 
abandon  most  of  the  present  towns  and  to  de- 
populate the  Zone,  leaving  only  enough  employes 
to  care  for  the  canal.  It  is  also  thought  that  the 
luxuriant  tropical  growth  will  soon  obliterate 
the  evidences  of  the  work  and  that  the  canal  will 
appear  as  a  natural  stream.  A  few  miles  from 
Colon  is  the  ancient  town  of  Porto  Bello,  which 
was  an  important  place  in  former  days,  and  was 
sacked  by  Morgan  and  other  buccaneers.  It  is 
now  of  importance  only  on  account  of  the  ex- 


cellent stone  quarries,  from  which  the  good  stone 
for  the  construction  of  the  canal  has  been  ob- 
tained. It  has  been  announced  that  ships  will 
sail  through  the  canal  on  January  i,  19 14,  and 
it  will  be  a  wonderful  sight  to  stand  on  the  porch 
of  the  Young  Men's  Christian  Association  Build- 
ing at  Culebra,  situated  high  up  on  the  hill,  and 
witness  the  first  ship  pass  through  the  great  cut 
far  below.  The  dream  of  the  ages  will  then  have 
been  realized  and  the  vision  of  the  seers  shall 
have  become  an  accomplished  fact. 


S<  )ME  POINTS  OF  INTEREST  AS  REGARDS  LONG  BONE  FRACTURES.* 


By  A.  Aldridge  Matthews,  M.D. 
Spokane,  AYash. 


There  is  today  at  hand  an  era  of  better  treat- 
ment for  fractures,  and  it  behooves  all  of  us  who 
expect  to  treat  these  cases  not  only  to  familiarize 
ourselves  with  the  best  methods,  but  also  to  per- 
fect ourselves  in  the  technic  if  we  hope  to  secure 
the  results  for  our  patients  which  they  are  certain 
to  demand. 

I  feel  a  hesitancy  in  saying  anything  further 
on  the  open  method  of  treating  fractures,  for  in 
the  last  couple  of  years  the  literature  has  been 
Hooded  with  articles  along  this  line.  While  at 
first  there  was  much  controversy  as  to  the  open 
method,  of  late  the  opposition  is  gradually  com- 
ing over  to  this  side.  I  myself  at  first  did  not 
receive  the  idea  with  very  open  arms,  but  as  some 
of  you  gentlemen  who  heard  me  give  a  paper 
mi  this  subject  as  early  as  two  years  ago  will  re- 
member.  I    was   partial   to   the   open  method    in 


•Read  before  Tri-State  Meeting  at  rortland,  Ore.,  .Tune  6, 
1912  (Washington,  Idaho  and  Oregon). 


many  fractures,  and  considered  it  the  only  treat- 
ment in  some.  There  are  some  today  that  I  did 
not  class  as  such  then,  but  I  think  are  better 
treated  by  that  means. 

I  consider  the  proper  view  in  regard  to  the 
treatment  of  fractures  is  to  treat  the  individual 
as  you  yourself  would  want  to  be  treated  if  in 
his  plight.  If  this  thought  would  pass  through 
our  minds,  I  believe  that  there  would  be  some 
fractures  treated  differently  than  they  are. 

There  are  certain  things  that  one  has  to  con- 
sider. Scudder  has  said  ''an  approximate  re- 
duction that  is  non-anatomic,  if  followed  by 
union,  and  by  a  functionally  useful  part  and  no 
apparent  deformity  to  the  patient  and  his  non- 
professional friends,  is  a  good  result."  I  agree 
with  Dr.  Scudder,  but  the  public  are  demanding 
even  more  than  this  ;  the)'  want  almost  anatomical 
exactness,  and  if  such  is  not  gotten  there  is  dis- 
satisfaction ;  therefore,  it  behooves  us  to  obtain 


THE    HOSPITAL   BULLETIN 


16.= 


a  good  cosmetic  as  well  as  anatomical  function- 
ing result,  and  this  endeavor  has  its  influence 
upon  popularizing  the  open  method  of  treatment. 
Patients  want  to  see  their  X-ray  pictures,  so  that 
they  can  know  that  the  ends  of  the  bones  are  in 
apposition,  and  if  after  being  discharged  they 
End  the  ends  not  in  apposition,  they  want  to 
know  why. 

Our  patients  should  be  told  what  ultimate  re- 
sult to  expect,  and  this  result  should  not  be  over- 
rated, for  often  perfect  restoration  to  normal  can- 
not be  had. 

This  has  been  brought  about  through  the  X-ra> . 
Individuals  often  go  and  have  X-rays  taken  on 
their  own  accord,  and  have  them  interpreted. 
X-rays  are  sometimes  taken  for  a  purpose,  such 
as  to  try  and  institute  malpractice  cases,  increas- 
ing slight  deformities,  making  them  appear  gross. 
This  is  not  an  uncommon  thing  to  be  done  when 
suits  are  brought.  I  know  of  one  case  which  was 
X-rayed  many  times  at  different  angles,  and  the 
worst  appearing  deformity  introduced  in  the  suit 
as  evidence. 

We  should  remember  that  an  X-ray  should  al- 
ways be  taken  in  two  directions — at  right  angles 
to  each  other — to  get  the  proper  interpretation. 
I  have  seen  a  number  of  X-rays  taken,  one  view 
showing  a  very  good  result  apparently  and  an- 
other at  a  right  angle  showing  overriding  or 
great  deformity.  This  js  especially  true  in 
oblique  fractures,  and  where  there  is  a  convexity 
or  concavity  in  line  of  the  rays.  To  interpret 
these  skiagrams  correctly  it  requires  some  study 
and  experience,  as  well  as  a  knowledge  of  osteol- 
ogy,  including  the  development  of  the  epiphyses. 

There  are  certain  conditions  which  make  it  im- 
possible to  have  all   of  our  fractures  X-rayed, 


while  I  admit  it  should  always  be  done  when  pos- 
sible ;  but  when  these  conditions  arise,  such  as 
fractured  pelvis,  thigh,  etc.,  where  one  cannot 
get  their  patient  to  an  X-ray  or  an  X-ray  be  got- 
ten to  them,  they  should  be  treated  in  the  manner 
that  one  is  most  certain  will  give  the  best  results, 
and  the  most  certain  method  is  unquestionably 
the  open  method.  I  do  not  mean  to  advise  the 
open  method  except  under  the  most  favorable 
circumstances,  where  one  can  depend  upon  abso- 
lute cleanliness  in  the  strictest  sense. 

I  am  well  aware  that  the  use  of  the  X-ray  in 
routine  fractures,  especially  in  the  country,  is 
impracticable  and  even  impossible  in  many  cases, 
but  that  does  not  mean  that  one  should  not  profit 
by  what  others  have  learned  by  the  use  of  the 
X-ray. 

Since  Dr.  Lane's  excellent  article  on  open 
treatment  of  fractures  the  profession  has  taken 
to  this  method  without  discretion,  and  many  cases 
have  been  operated  upon  by  men  poorly  equipped 
and  qualified  to  do  this  work,  and  worse  results 
gotten  thereby  than  if  the  closed  method  had  been 
adhered  to.  I  have  been  unfortunate  enough  to 
have  had  several  of  these  cases  come  under  my 
care  in  the  past  few  months. 

As  regards  materials  to  be  used  for  the  open 
method  in  long  bones,  as  a  whole  I  prefer  the 
metal  plate  and  screws ;  I  do  not  mean  to  exclude 
other  devices,  for  there  are  conditions  and  places 
where  the  plate  cannot  be  used  and  other  methods 
more  satisfactory  used,  such  as  nails,  pegs,  wire, 
screws,  staples,  etc.  Bone  clamps  for  holding 
the  fragments  until  union  of  the  bone  and  relaxa- 
tion of  the  muscles  is  sufficient  to  keep  them  in 
their  normal  position  by  external  support  should 
be  condemned,  or  anv  device  which  communicates 


,..  -  -'-■-:  ~r 

— 

A 

. 

m 

8 

C 

FIG.    1. 

A  represents  the  various  sizes  of  drill  points. 

E,  silv.r  plate,  the  holes  drilled,  which  may  be  cut  the  desired  length. 

C,  ordinary  carpenter  drill   (reciprocating),  found  most  satisfactory  in  my  bone  work. 


1 66 


THE    HOSPITAL    BULLETIN 


with  the  air.  as  there  is  great  danger  of  infection, 
which  it  is  practically  impossible  to  prevent. 

The  plate  which  is  shown  in  several  of  the  cuts 
is  made  of  silver,  and  varies  in  size.  I  have  been 
using  them  for  the  past  six  or  seven  years.  I 
had  a  quantity  made  with  screw  holes,  as  is  shown 
in  the  Fig.  8 ;  also  screws,  but  the  silver  screws 
I  discarded,  and  used  the  ordinary  steel  ones. 
The  reason  for  discarding  the  silver  ones  was 
that  they  were  too  soft,  and  it  was  a  common 
tiling  to  twist  off  their  heads.  The  plate,  as  you 
see,  is  quite  long,  and  1  cut  it  off  the  length  that 
I  desire;  it  is  very  pliable,  and  has  this  advan- 
tage over  the  Lane  plate  in  that  respect,  and  there 
is  no  chance  of  breaking  or  the  screw  holes  break- 
ing out  on  account  of  it  being  brittle.  I  have  seen 
reports  of  this  happening  with  the  steel  plate, 
but  I  understand  now  these  plates  can  be  had  of 
some  more  pliable  and  softer  material.  The  ad- 
vantage of  the  pliable  plate  can  readily  be  seen. 
It  will  give  to  a  degree,  and  often  will  save  the 
pulling  out  of  the  screws  or  breaking  the  plate. 

The  silver,  and  later  bronze,  wire  which  was 
so  popular  three  or  four  years  ago  has  been  re- 
duced very  much  in  bone  work  since  the  plate 
method  has  become  prevalent,  and  righth  so. 
While  there  are  still  many  places  where  the  wire 
has  its  use.  such  as  patellar,  olecranon  and  in 
comminuted  fractures  of  long  bones  where  there 
are  many  fragments  and  considerable  of  the 
shaft  is  involved.  I  wish  to  condemn  the  use  of 
the  wire  for  encircling  long  bones,  as  is  often 
done  in  oblique  fractures,  for  it  may  cause  an  am- 
putation of  the  bone ;  especially  this  should  be 
borne  in  mind  in  the  treatment  of  children  where 
there  is  much  growth  of  the  bone  yet  to  take 
place.  Dr.  Blake  of  New  York  has  recently  re- 
ported an  incident  of  this  character.  It  is  also  a 
poor  device  to  suture  long  bones  with,  for  ;t 
allows  too  much  motion,  often  causing  bowing 
and  displacement. 

I  have  tried  and  own  several  drills,  but  the 
most  satisfactory  one  is  shown  in  Fig.  i,  which 
I  gol  at  a  hardware  store.  It  is  the  ordinary 
two-way  cutting  carpenter  drill,  known  as  re- 
ciprocating drill,  and  the  drill  points,  which  can 
be  had  of  any  size,  the  regular  steel  bits.  These 
bits  can  be  improved  upon :  it  is  a  disadvantage 
to  have  the  thread  the  whole  length,  being  much 
better  to  only  thread  it  one-half  inch  from  point. 
for  if  one  is  not  careful  the  soft  tissue  in  prox- 
imity   with    it    will   wind  around   when    drilling, 


Flo.    2. — Fractured    femur   with   application   of   silver   plate. 
Radiograph  taken  about  12  weeks  after  plate  being  applied. 


which  could  nut  happen  if  the  upper  part  of  the 
bit  were  round  and  smooth. 

To  insure  the  best  results  in  the  open  method 
of  treatment  in  fractures  the  operation  should 
be  performed  with  neatness  and  dexterity,  with 
the  aid  of  proper  instruments  to  insure  as  little 
trauma  to  the  tissue  as  possible. 

Dr.  Joseph  A.  Blake  has  said  what  one  sur- 
geon may  be  able  to  do  rapidly,  accurately  and 
cleanly  would  be  impossible  for  another ;  so  there 
are  considerations  to  be  taken  into  account  other 
than  the  condition  pre-ent  in  the  patient.  In 
fact,  there  is  no  province  in  surgery  in  which  the 
result  depends  more  upon  the  mechanical  skill 
and  cleanliness  of  the  operator. 

The  majority  of  my  plates  have  eventually 
come  back  to  me  for  removal.  While  the  opera- 
tion of  removal  is  trivial,  the  wound  usually  heals 
unite  slowly;  especially  is  this  the  case  in  the  leg. 
The  reason  for  this  may  be  on  account  of  the 
tendency  to  swelling,  etc.,  after  operations  and 
injuries  to  these  parts. 

A  point  that  has  been  brought  very  forcibly  to 
my  attention  in  several  direct  injury  cases  causing 
fracture  is   that   they  are  very  much   slower   in 


THE    HOSPITAL    BULLETIN 


167 


PIG.  3.— Same  as  Fig 


hut  different  view. 


getting  union  than  indirect  injuries,  and  that 
there  is  a  much  greater  tendency  to  bone  death. 
Whether  this  is  due  to  injury  of  the  nerve  or 
blood  supplies  I  am  not  prepared  to  say,  but  am 
inclined  to  think  that  is  the  most  probable  cause. 
C'rile  has  demonstrated  in  animals  that  fright  and 
shock  is  a  cause  for  delayed  union.  Mild  infec- 
tion does  not  seem  to  interfere  with  the  healing 
of  a  fracture,  but  on  the  contrary  seems  to  stimu- 
late the  formation  of  callus ;  but  infection  severe 
enough  to  cause  necrosis  of  tissue  manifestly  will 
prevent  union. 

One  of  the  greatest  improvements  toward  the 
avoidance  of  infection  is  the  improvement  of  our 
instruments.  We  now  have  devices  for  reducing 
Fragments;  also  various  bone  clamps  for  holding 
the  plate  and  fragments,  ami  must  of  all.  the 
traction  devices,  such  as  that  devised  by  Ridlon 
of  Chicago.  The  modification  of  his  by  1  )r. 
Eikenbary  of  Spokane  is  the  best  one  T  have 
seen  and  one  that  I  use.  which  is  shown  in 
IT.;.  4.  The  great  advantage  of  this  in  frac- 
tures of  the  lower  extremity  is  that  we  can  oper- 
ate and  apply  our  plaster  without  removing  the 
stretcher,  get  any  amount  of  traction,  which  is 
constant:  also  lessening  the  number  of  hand-  to 


help,  and  there  is  no  chance  of  breaking  the  plate 
or  device  used  to  hold  the  fragments  while  the 
external  dressings  are  being  applied,  for  this  is 
quite  liable  to  happen  when  held  by  hand.  <  >ur 
external  dressings,  whether  plaster  or  what  not, 
are  the  supports  which  have  always  been  and  are 
most  relied  upon  now,  even  with  our  internal  im- 
provements, and  should  never  be  neglected. 

If  there  was  no  danger  or  bad  results  con- 
nected with  the  open  operation,  it  would  unques- 
tionably be  the  ideal  method  to  treat  all  fractures. 
But  it  has  been  found  that  infection  may  take 
place,  and  an  infection  in  a  fracture  is  a  com- 
pound fracture,  for  an  open  treated  fracture  is 
nothing  more  than  that,  and  is  always  a  serious 
condition,  and  has  frequently  led  to  the  loss  of 
limb,  or  even  life. 

Danger  of  primary  wound  infection  has  been 
eliminated  in  other  operations,  and  there  is  no 
reason  why  it  should  not  be  done  here,  and  this 
can  only  be  achieved  by  the  highest  technical 
skill,  for  bone  freshly  opened  seems  to  have  less 
resistance  to  infection  than  any  other  tissue  of  the 
body.  Lane  of  London  has  worked  out  this 
technic,  and  has  shown  us  what  good  results  can 
be  had. 

As  regards  the  preparation  for  these  opera- 
tions, or  any  operation,  soap  and  water  has  been 
relegated  to  the  background  for  at  least  tj  hours. 
My  routine  for  preparing  the  field  for  any  oper- 
ation is  to  have  the  part  shaved,  thoroughly 
washed  with  soap  and  water  the  night  before,  then 
washed  with  alcohol  and  allowed  to  dry ;  then  a 
sterile  towel  is  applied  to  the  part,  with  no  further 
preparation  until  the  patient  is  placed  on  the  oper- 
ating table,  where  the  operative  field  is  swabbed 
off  with  benzoin  or  benzoin  and  iodine  1-1000  and 
allowed  to  dry,  which  removes  the  oil  from  the 
skin,  and  it  is  also  a  disinfectant;  then  apply  a 
liberal  coat  of  one-half  strength  tincture  iodine 
with  alcohol  and  allow  to  dry. 

In  compound  fractures  these  wounds  should 
not  be  washed  with  soap  and  water,  as  we  did 
formerly,  but  the  part  shaved  either  dry,  or  use 
alcohol  or  benzoin  to  wet  the  part  for  shaving, 
and  then  apply  the  iodine.  The  gross  dirt  should 
be  picked  or  trimmed  away  from  the  wound  and 
part  painted  with  iodine,  the  projecting  bone  frag- 
ments also  painted,  then  allowed  to  dry  before 
being  returned.  This  method  is  much  more  sim- 
ple and  easier  than  the  older  methods,  and  very 
much  more  satisfactorv. 


1 68 


THE    HOSPITAL    BULLETIN 


I  wish  to  take  this  opportunity  to  thank  Dr. 
W.  W.  Potter  for  the  excellent  X-ray  work  he 
has  done  for  me,  some  of  which  is  shown  here. 

"Since  writing  this  article  I  have  been  favor- 
ably impressed  with  Sherman's  steel  plate.  They 
seem  to  fill  the  bill  very  satisfactorily,  and  have 
quite  an  advantage  over  the  Lane  plate  and  also 
over  the  silver  plate  that  I  have  used  so  much, 
and  recommend  it  in  my  article." 

Case  I. — White  ;  male ;  age,  37.  Was  run  over 
by  a  dirt  car,  causing  a  severance  of  all  the  ex- 
tensor muscles  of  the  anterior  thigh  and  a  com- 
pound fracture  of  the  left  femur.  Patient  was 
in  extreme  shock  when  he  came  under  my  care, 
and  after  waiting  a  short  while,  and  by  the  use  of 
stimulants,  I  was  able  to  go  ahead  and  sew  the 
muscles  together ;  put  the  patient  up  in  long  side 
splints  with  extension.  This  I  kept  on  for  about 
a  week,  but  on  account  of  the  drainage  it  was 
necessary  to  remove  the  splint  and  apply  a  plaster 
one,  so  that  I  could  get  better  access  to  the  wound 
through  a  window  in  the  cast.  The  wound  re- 
mained open,  and  after  the  lapse  of  about  10 
weeks  I  removed  my  plaster  and  found  there  was 
absolutely  no  union.  When  I  opened  down  on 
the  bone  I  found  that  necrosis  of  both  ends  had 
taken  place,  and  it  was  necessary  to  resect  the 
dead  bone.  Then  I  applied  a  silver  plate  with  six 
screws,  which  is  shown  in  Fig.  2.  This  patient 
made  an  excellent  recovery,  but  has  about  three 
inches  shortening. 

Case  II. — White ;  male ;  age,  23.  Had  a  crush- 
ing injury  to  right  leg,  causing  a  compound  com- 
minuted fracture.  His  foot  was  also  crushed. 
and  it  was  necessary  to  remove  four  of  his  toes 
and  one  of  the  metatarsal  bones.  This  was  done 
some  time  after  the  accident,  and  the  dorsal  part 
of  the  foot  was  skin-grafted,  as  the  skin  was  torn 
off  from  the  upper  part  of  the  ankle  clear  down. 
I  applied  a  silver  plate  with  five  screws.  This 
patient  made  an  uneventful  and  most  satisfactory 
recovery. 

Case  III. — White;  male;  age,  46.  Compound 
comminuted  fracture  of  both  bones  of  right  leg. 
The  injury  was  caused  by  direct  violence,  a  heavy 
blow  being  received  on  the  leg.  driving  out  a 
piece  of  bone  about  two  inches  long  from  the 
middle  of  the  shaft.  This  patient  I  operated 
upon  immediatelly,  found  the  proximal  and 
distal  fragments  together,  and  the  intervening 
piece  driven  out  in  the  soft  parts.  By  consider- 
able traction  I  was  able  to  separate  the  fragments 


and  work  this  intervening  piece  up  into  position, 
and  applied  a  long  plate  with  a  screw  in  either 
end  and  one  in  the  middle,  which  pulled  up  and 
held  the  intervening  fragment  in  position. 

Case  IV. — White;  male;  age,  37.  Had  a 
crushing  injury  received  to  middle  of  shaft  of 
left  leg,  causing  a  compound  and  much  com- 
minuted fracture  of  tibia  and  fibula.  This  case 
1  operated  upon  immediately ;  found  the  bone  for 
about' six  inches  in  the  tibia  comminuted  and  the 
fragments  very  much  displaced  in  every  direc- 
tion. These  fragments  I  molded  into  position 
and  wired  as  best  I  could.  This  patient  made  an 
uneventful  recovery,  and  is  doing  hard  work, 
which  requires  the  use  of  his  leg  all  the  time. 

Case  V. — White;  male;  age,  t>7-  Engineer  by 
trade ;  referred  to  me  by  the  Drs.  Abrams  of  Hill- 
yard  ;  was  shot  accidentally  by  a  48-caliber  bullet 
through  the  lower  end  of  his  humerus,  bullet 
passing  directly  through  the  arm.  This  case  I 
did  not  see  until  the  day  following  the  accident, 
and  then  reduced  the  fragments  and  secured  them 
together  with  a  steel  peg  and  wires.  This  patient 
made  an  uneventful  recovery,  and  is  now  work- 
ing at  his  trade  :  has  good  motion,  sufficient  as  not 
to  interfere  with  his  work,  and  I  anticipate  will 
eventually  improve  considerably  over  his  present 
condition.  He  suffers  no  inconvenience  whatso- 
ever from  the  wire  or  from  the  steel  peg  in  the 
bone. 

Case  VI. — White:  male:  age.  25.  Has  had  a 
fracture  of  right  radius,  due  to  a  direct  violence 
blow.  This  fracture  was  put  up  in  splints,  and 
it  was  thought  reduced,  but  upon  taking  an  X-ray 
it  was  found  there  was  considerable  overriding, 
so  the  physician  in  charge  attempted  to  reduce  by 
the  open  method,  and  wired.  The  patient  was 
then  put  up  in  splints  and  kept  there  for  several 
weeks ;  the  wound  remained  open,  and  after  some 
time  the  splints  were  removed  and  an  X-ray  again 
taken.  ( I  regret  that  I  have  not  these  X-rays  b  1 
show,  but  I  was  fortunate  enough  to  see  them.  1 
As  the  sinus  persisted,  the  arm  was  again  opened. 
wire  removed,  but  the  deformity  was  left. 

This  patient  fell  into  my  hands  several  weeks 
after  this.  He  had  a  very  limited  motion  and  con- 
siderable ankylosis  of  his  fingers,  and  almost 
complete  ankylosis  of  the  wrist,  and  was  very 
much  incapacitated  thereby.  I  suggested  to  him 
the  opening  down  and  correcting  the  deformitv. 
which  he  consented  to  having  done.  When  I 
Opened  down  I  found  the  bone,  with  the  distal  end 


THE    HOSPITAL    BULLETIN 


169 


I'lii.  4. — Traction  device  ;is  appears  when  applied  to  patient  :  it  can  be  nsed  either  on  one  or  both  legs  at  a  time,  as  is  desired. 


bowed  out ;  it  was  with  much  difficulty  that  I  was 
able  to  get  it  clown  in  line  with  the  approximate 
end,  which  I  succeeded  in  doing  by  applying  a 
plate.  When  a  plate  was  taken,  three  weeks  after 
the  operation,  it  could  be  seen  that  the  constant 
strain  and  pulling  of  the  lower  fragments  had 
pulled  the  screws  up  a  little.  It  was  necessary  to 
remove  this  plate,  as  a  sinus  persisted.  This  was 
done  by  my  associate  during  my  absence,  about  10 
weeks  after  the  plate  had  been  applied.  At  that 
time  the  patient  was  doing  and  had  been  doing 
splendidly,  but  after  the  removal  of  the  plate  for 
some  unknown  reason  the  patient  was  taken  ill 
immediately,  and  died  within  the  next  few  days 
from  some  rather  obscure  condition,  it  being  pos- 
sibly a  septic  condition,  although  the  wound  was 
laid  wide  open  and  packed  at  the  time  the  plate 
was  removed  and  no  stitches  taken.  This  is  the 
first  and  only  fatal  case  of  this  character  that  I 
have  had.  The  bone  was  thoroughly  united,  and 
apposition,  I  am  told,  was  excellent. 

Case  I'll  represents  a  man  hurt  in  a  wreck 
in  which  he  had  both  legs  fractured.  1  did  not 
see  him  until  about  id  weeks  after  his  injury, 
and  at  that  time  he  had  an  ununited  fracture  of 
his  right  leg,  with  a  great  deal  of  crepitus  and  a 
number  of  sinuses  running  pus  scattered  all  along 
his  mid  thigh.  An  amputation  had  been  advised, 
and  he  was  sent  here  for  that  purpose. 

After  examining  him  I  advised  a  resection  and 
removal  of  about  the  middle  third  of  his  thigh 
bone,  for  it  was  very  plain  to  see  that  the  fracture 
was  comminuted  and  a  quantity  of  dead  bone 
was  present.     The  right  leg  was  united. 

On  September  21,  1909,  I  opened  and  removed 
two  large  spicule*   and  then  resected  both  of  the 


ends  of  the  femur.  The  bone  removed  was  dead, 
and  some  of  it  had  a  worm-eaten  appearance, 
showing  absorption  was  taking  place.  Then  I 
applied  a  silver  plate  with  three  screws  below  and 
two  above.  After  a  very  protracted  stay  in  the 
hospital  he  managed  to  get  a  good,  useful  leg, 
which  he  can  walk  about  on  very  well,  although 
it  is  about  six  inches  shorter  than  it  was  before 
the  accident ;  but  he  wears  a  high  shoe  on  his 
foot  and  uses  a  cane.  Fortunately,  the  other  leg 
is  about  four  inches  shorter  than  it  was  formerly, 
on  account  of  the  overriding  from  the  other  frac- 
ture.   This  may  be  called  a  fortunate  mistake. 

In  an  X-ray  taken  shortly  after  the  operation 
a  slight  bending  of  plate  and  a  little  displace- 
ment of  ends  is  possibly  due  to  the  position  in 
which  it  was  put  up  following  the  operation,  and 
the  soft  parts  were  puckered  up  in  the  middle 
thigh,  which  gradually  contracted  and  took  care 
of  the  slack. 

I  took  an  X-ray  recently,  two  years  and  nine 
months  after  plate  was  applied.  Recently  a  sinus 
which  formed,  healed  and  reformed  two  or  three 
times,  was  responsible  for  my  taking  the  last  X- 
ray,  which  shows  the  middle  screw  in  the  lower 
fragment  is  loose  and  has  worked  its  way  almost 
out.  I  will  remove  the  screw,  but  will  not  disturb 
the  plate  unless  further  trouble  develops,  which 
I  rather  think  is  doubtful,  on  account  of  the  sinus 
healing  up  a  couple  of  times  previous. 


Dr.  S.  DeMarco,  class  of  1900,  has  returned 
from  a  huntirtg  trip  in  the  wilderness  of  Maine. 
He  hoped  to  bring  back  a  moose,  a  bear  and  sev- 
eral deer,  but  some  of  the  boys  "don't  know  yet 


what  he  got. 


170 


THE    HOSPITAL   BULLETIN 


ADDRESS  OP  PROF.  ADOLPH  BICKEL 
OF  THE  UNIVERSITY  OF  BERLIN  DE- 
LIVERED TO  STUDENT  BODY  OF  THE 
UNIVERSITY  OF  MARYLAND,  OC- 
TOBER 5,  1912. 


It  has  been  a  great  pleasure  to  me  to  be  the 
guest  of  such  an  ancient  and  distinguished  uni- 
versity. You  may  be  interested  to  know  that 
in  a  journalistic  endeavor  1  have  been  associated 
with  your  professor  of  physiology  for  several 
years.  For  being  the  editor-in-chief  of  the  In- 
ternational Archives  of  the  Pathology  of  Diges- 
tion and  Metabolism — I  selected  your  Professor 
Hemmeter  as  my  American  editor  after  the 
death  of  Dr.  Christian  A.  Flerter  of  New  York. 
But  yesterday  at  dinner  I  discovered  that  Pro- 
fessor Hemmeter  and  1  are  fellow-alumni,  for  he 
studied  at  the  same  school,  the  Konigliches  Real- 
gymnasium  at  Wiesbaden,  which  is  my  native 
city.  So  that  I  may  claim  a  personal  acquaint- 
ance with  your  teacher  and  in  addition  to  this  I 
am  familiar  to  a  limited  degree  with  the  edu- 
cational and  scientific  history  of  the  University 
of  Maryland. 

For  wherever  medicine  has  a  student  it  is 
known  that  it  was  James  Carrol  who  discovered 
that  yellow  fever  is  transmitted  by  the  bite  of  a 
specific  mosquito,  and  so  heroically  submitted 
himself  to  the  bite  of  an  infected  mosquito,  vol- 
untarily made  himself  the  object  of  experiment 
and  suffered  a  severe  attack  of  yellow  fever, 
from  which  he  later  on  died.  To  have  produced 
such  a  brilliant  discoverer  and  martyr  to  science 
is  an  achievement  of  which  any  university  can 
be  proud.  It  is  known  also  that  your  alumnus 
Henry  C.  Carter  led  up  to  this  great  discovery 
by  his  thorough  study  of  the  extrinsic  period  of 
incubation  of  yellow  fever.  It  may  be  said  that 
the  scientific  work  of  Carrol  and  Carter  on  the 
etiology  of  yellow  fever  made  possible  the  con- 
struction of  the  Panama  Canal.  And  1  con- 
gratulate the  Regents  of  this  University  on  hav- 
ing produced  such  an  alumnus  as  Gen.  Rupert 
L.  Blue,  who  stamped  out  the  bubonic  plague 
from  San  Francisco,  and  now  holds  the  highest 
medical  office  within  the  gift  of  the  United 
States  Government. 

A  well-known  saying  of  the  gospels  is  to  the 
effect  that  "a  prophet  is  not  without  honor  ex- 
cept in  his  own  country."  From  what  I  heard 
of  your  professors  during  my  short  trip  in  this 


country,  I  know  that  they  are  considered  most 
effective  teachers;  but  it  is  to  the  department  of 
physiology  that  your  greatest  reputation  in  Ger- 
many is  due,  for  your  professor  of  physiology 
has  published  some  of  his  most  brilliant  research 
work  in  Germany,  and  I  can  assure  you  that  the 
German  Physiologic  Society  is  proud  of  his 
membership  and  that  nothing  would  gladden  the 
hearts  of  the  German  confreres  more  than  to 
hear  that  the  Regents  had  more  liberally  endowed 
the  laboratory  of  physiology — for  from  this 
source  we  may  expect  the  most  telling  research 
work,  espscially  in  that  specific  domain,  Physi- 
ology of  Digestion,  in  which  he  is  an  authority 
of  international  reputation.  Some  of  his  dis- 
coveries have  already  been  confirmed  in  my  own 
institute. 

I  urgently  recommend  the  encouragement  of 
physiologic  and  pathologic  research  in  this  uni- 
versity, and  with  such  able  teachers  as  you  are 
foitunate  enough  to  possess  this  University  can- 
not fail  to  rise  to  higher  and  higher  standards. 

May  the  interests  of  the  University  of  Mary- 
land be  united  to  the  noble  purpose  of  higher 
medical  education,  so  that  it  may  resume  a 
standard  that  is  destined  by  Divine  Providence. 

Professor  Hemmeter  in  introducing  him  said : 

"While  the  Americans  as  a  nation  believe  in 
high  tariff,  there  is  no  tariff  on  intellect,  and 
while  the  American  people  do  not  believe  in 
monarchs,  they  are  always  glad  to  welcome  the 
monarchs  of  science.  The  great  physiologist, 
Ludwig,  of  Leipsig,  once  said  to  my  teacher, 
Prof.  FT.  Newel  Martin :  All  das  Wasser  welches 
uns  trennt  kann  die  Flamme  der  Bewunderung 
nicht  loschen,  die  ich  fur  Ihre  rastlose  Thatigkeit 
empfinde,  which  means  'All  the  water  that  sepa- 
rates us  cannot  extinguish  the  flame  of  admira- 
tion which  I  feel  for  your  wonderful  and  restless 
activity,'  and  these  are  the  words  that  I  feel 
are  due  in  introducing  to  you  Prof.  Adolph 
Uickel,  whose  only  address  in  America  will  be- 
to  you,  my  students." 


The  Senior  Class  election  of  officers  resulted  as 
follows  :  Norbert  C.  Nitsch,  president ;  Claudius 
A.  Hayworth,  vice-president;  Frank  P.  Callahan, 
secretary  ;  Elmer  Newcomer,  treasurer  ;  Hamilton 
J.  Slusher,  chairman  of  executive  committee ; 
Earle  Griffith  Breeding,  editor-in-chief.  The  re- 
maining officers  will  be  elected  at  some  future 
date. 


THE    HOSPITAL    BULLETIN 


i/i 


THE   HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Suryery 
PUBLISHED  BY 

THE   HOSPITAL  BULLETIN   COMPANY 

608  Professional  Building 

Baltimore,  t»' u. 


SECURING    FUNDS. 


Subscription  price,     .     .     .     $1.00  per  annum  in  advance 

Reprints   furnished   at   cost.     Advertising   rates 

submitted  upon  request 


Nathan  Winslow,  M.D.,  Editor 


Baltimore,  November  15,  1912. 


STATUS    OUO. 


We  arc  pleased  to  announce  that,  having  com- 
plied with  the  New  York  rules  in  regard  to  six 
salaried,  full-time  instructors,  as  well  as  meeting 
their  other  requirements,  the  Medical  Department 
of  the  University  of  Maryland  has  been  regis- 
tered for  four  full  years  by  the  educational  de- 
partment of  the  State  of  New  York.  This  means 
that  our  graduates  are  eligible  to  appear  before 
the  Board  of  Examiners  of  New  York,  and,  if 
successful  in  passing  the  examinations,  they  will 
be  licensed  to  practice  in  that  State.  This  is  no 
empty  honor,  as  there  are  many  schools  that  are 
placed  in  class  A  by  the  American  Medical  Asso- 
ciation that  are  not  registered  by  the  New  York 
authorities,  and  whose  graduates  cannot  practice 
in  New  York  until  they  have  taken  an  additional 
rear  in  some  other  institution.  Moreover,  those 
schools  that  are  registered  cannot  give  advanced 
standing  to  the  students  of  non-registered  schools. 
As  we  have  declined  to  give  advanced  standing  to 
the  students  of  some  of  these  "accredited"  schools, 
whom  we  formerly  accepted,  it  is  with  great  satis- 
faction that  we  are  able  to  state  that  the  enroll- 
ment of  students  for  the  present  session  is  but 
little  less  than  that  of  last  year,  and  that  the  new 
men  entering  upon  the  study  of  medicine  are  of 
an  exceptionally  good  class.  The  work  of  the  ses- 
sion began  promptly,  and  has  been  conducted  with 
enthusiasm.  The  new  men  who  are  now  filling 
their  first  terms  of  service  with  us  are  not  only 
well  qualified  for  their  positions,  but  are  proving 
themselves  valuable  acquisitions  to  the  school. 
On  the  whole,  then,  we  are  well  satisfied  with  the 
present  status. 


Some  months  ago  the  cry  "On  to  Homewood!" 
resulted  in  bringing  $1,000,000  to  a  celebrated  in- 
stitution of  this  city.  Within  the  past  few  weeks 
the  threat  that  another  institution  would  leave 
Baltimore  and  go  to  Chicago  unless  $700,000  was 
raised  in  the  city  and  State  resulted  in  securing 
nearly  half  a  million  dollars  for  that  institution. 
It  is  time  for  the  University  of  Maryland  to  bestir 
itself  and  to  adopt  a  slogan  which  the  people  will 
hear  and  heed:  "Help  us  or  we  close."  The 
closure  of  the  medical  and  other  professional 
schools  of  the  University  of  Maryland,  after  an 
honorable  and  useful  existence  of  more  than  100 
years,  would  also  be  a  calamity  to  the  city  and 
State  that  they  could  ill-afford  to  suffer.  We 
must  have  outside  assistance  in  the  near  future 
or  die  of  starvation.  We  believe  we  shall  receive 
this  assistance.  In  the  meanwhile,  let  each  alum- 
nus contribute  something  to  the  pathological  fund. 
We  would  like  to  have  the  department  of  path- 
ologv  endowed  by  the  alumni  and  largely  con- 
ducted by  them.  At  the  present  time  the  funds 
available  for  this  purpose  approximate  $20,000. 
We  need  $100,000  for  the  department,  and  an 
endowed  professorship  of  pathology  could  be 
founded  for  $50,000.  The  additions  to  the  fund 
in  October  were  insignificant,  but  better  than 
nothing. 

CONTRIBUTION     BY    CLASSES. 

1848 $50  00 

1864 20  OO 

1868 IO  OO 

1871 35  00 

1872 81  84 

1873 441  83 

•1874 5  00 

1875 5  00 

1876 115  00 

1877 10  00 

1880 5  00 

188 1 250  00 

1882 310  00 

1883 40  00 

1884 40  00 

1885 235  00 

1886 100  00 

1888 50  00 

1889 100  00 

1890 1 73  00 

1892 150  00 


i-2  THE    HOSPITAL    BULLETIN 

1893 40  00  been   permeated   by    the   university    idea,    which 

1894 135  00  represents  organized  co-operation. 

'■^95 J55  °°  It   is   an   interesting   fact   that   Maryland   was 

1896 52  00  quite  in  line  with  Northern  States  in  this  regard 

1897 80  00  at  the  start,  for  the  university  idea  was  projected 

s 1 15  od  by  the  founders  of  Maryland  in   1C40,  and  even 

1899 5°  °°  in  1784,  as  you  know,  the  charter  of  St.  John's 

1900 215  00  College  at  Annapolis  authorized  it  to  enter  into 

1901 270  00  an  alliance  with  a   Maryland  university.     This, 

1902 330  00  we  have  been   told,  was  the   dream   of   George 

1903 315  00  Washington,  a  matriculate  of  St.  John's. 

I0°4 135  00  But  further,  in  1812,  history  tells  us  that  the 

!9°5 22°  °°  University  of  Maryland  was  constituted  as  such 

J9°6 175  °°  by  an  act  of  the  General   Assembly  which  em- 

I9°7 no  00  powered  the  then  College  of  Medicine  of  Mary- 

I9°8 20  00  land  (  chartered  in  1807)  to  annex  to  itself  other 

x9°9 5  00  faculties,    viz.,    those    of    divinity,    law    and    the 

I9I° 5°  O0  sciences  in  the  city  and  "precincts"  of  Baltimore. 

1911  Terra  Mariae 3  5°  You  are  aware,  however,  that  no  such  annexa- 

10 12  Club  Latino  Americano 25  00  tion  took  place,  one  reason  being  that  the  theo- 

logical  department  never  materialized.     The  pro- 
Total  subscriptions  to  Nov.  1.  1912.  .810,280.17  visions  of  the  charter  relating  to  such  a  depart- 

NEW  subscriptions  IN  OCTOBER.  ment    were    s«mingly    impracticable.      The    de- 

_,     XT    „    T^    ..                                                ^  partments  of  law  and  medicine,   however,  pro- 

Dr.  A.  S.  Dudley,  iqoi Sio  00  ,    ,                                  ,                               , 

_      _     T      t,  ,         „  „  ceeded   to   operate   together   under   the   charter. 

Dr.   R.  L.   belts.    [808 10  00  ,.        .     ,        ,,    ,  „,      .        .    ,                     •       .-,0 

_      _     .     „           ,          -  lour  body  added  the  dental  department  m  1882 

1  Ir.  (  ).  A.  Howard.  1006 10  00  ,  .                .       ,                       .     .                     ... 

and  in  1904  the  department  of  pharmacy,  which 

.„      ,                                                               „  had   for  60  years   led   a   separate   existence.     I 

lotal Smoo  '      it    .1           r     .             .i         1 

venture   to    recall    these    facts,    as   they   have    a 

bearing  on  the  future  of  the  University. 

CORRESPONDENCE  ^ou  have  been  successful  for  several  reasons. 

and  first,  I  believe,  because  you  have  taken  care 

September  25,  1912.  tQ   secure  soun(j  and   efficient   teachers   in   your 

To  the  Honorable,  the  Board  of  Regents  of  the  several    departments ;    men    who    have    realized 

L  niversity  01  Maryland.  their  opportunities  and  responsibilities,  and  have 

Gentlemen:  had  the  practical  experience  necessary  to  make 

The  relations  of  modern  universities  to  educa-  their  teaching  attractive  and   forceful.     AYe   all 

tional  as  well   as  social  and   economic  progress  know  that  it  is  the  quality  of  the  teaching  more 

are  burning  questions  in  our  country  just  now.  than  anything  else  that  has  enabled  you  to  en- 

In  respect  to  the  organization  of  our  universi-  roll  more  than  1100  pupils  during  the  session  of 

ties,  we  have  come  to  realize  that  the  time  is  at  1911-12.     Teaching  is  an  art  not  easily  acquired, 

hand  when  the  average  Medical  and  Law  School,  It  is  usually  inborn.     Many  of  the  most  learned 

]  tental   College   or   School   of   Pharmacy  ought  and  even  the  most  distinguished  men  in  profes- 

not  to  struggle  along  trying  to  keep  up  a  separate  sional  life  do  not  possess  it.    And  yet  it  is  essen- 

existence,   since   it  can  operate  more  effectively  tial  in  a  successful  teaching  body.     But  you  have 

and  with  less  expense  under  the  aegis  of  a  uni-  been  rich   in   achievements.     Not  to  go  beyond 

versity.  the  limits  of  our  own  profession,  the  names  of 

"La  union  fait  la  force"  is  an  adage  that  has  Nathan  R.  Smith  and  Elisha  Bartlett  would  have 

almost    universal    application    in    successful    or-  shed  luster  on  any  institution.    And,  again,  some 

ganization,  of  the  most  distinguished  professors  of  medicine 

One  has  but  to  point  to  the  great  strides  made  now  in  office  in  other  universities  were  graduates 

by  Yale.  Harvard  and  Columbia  since  they  have  of   your   old   University.      And   you   have   been 


THE    HOSPITAL    BULLETIN 


173 


pioneers.  I  am  told  that  you  were  the  iir>i 
medical  institution  to  introduce  compulsory  dis- 
section of  the  human  body.  You  were  the  firsl 
in  put  the  teaching  of  hygiene  and  medical  juris- 
prudence into  the  curriculum.  You  were  also 
the  first  to  make  the  teaching  of  the  diseases  of 
women  and  children  the  specialties  that  they  are 
now. 

Your  progress  has.  however,  been  hindered 
b)  lack  of  funds  and  lack  of  appreciation  on  the 
part  of  the  people  of  Maryland  of  what  you  have 
done  and  are   doing. 

Idle  modern  university,  embodying  as  it  dues 
the  highest  ideals  in  education,  needs  and  should 
have  more  genera!  support  than  it  has.  In  the 
medical  department  large  sums  are  necessary  to 
fulfill  its  requirements  and  the  more  active  the 
movement  in  the  direction  of  larger,  more  nu- 
merous and  better  ecpiipped  laboratories,  the 
greater  the  progress  that  can  be  made,  as  we 
know,  toward  the  ultimate  eradication  of  disease. 
The  department  of  physiology  in  the  University 
of  Maryland  is  liberally  supplied  with  money, 
but  other  departments  have  not  been  so  fortunate. 
But  to  come  to  the  question  of  the  hour.  Who 
is  to  be  selected  to  fill  the  vacancy  caused  by  the 
death  of  your  late  provost;  a  man  who  honored 
the  University  and  was  honored  by  his  position, 
Bernard  Carter,  the  able  jurist  and  patriotic  citi- 
zen, known  for  his  rare  ability  as  well  as  for 
his  charming  social  qualities  the  whole  length 
and  breadth  of  our  land?  Whom  will  you  now 
select  to  guide  the  destinies  of  your  institution 
with  dignity  and  success? 

You  will  naturally  have  in  view  a  representa- 
tive man  in  touch  .with  the  university  idea,  with 
the  education  movements  of  the  day  and  their 
leaders;  a  man  also  of  attractive  personality  and 
ripe  experience.  I  am  unaware  if  the  pecuniary 
stipend  would  justify  the  acceptance  of  the  posi- 
tion by  President  Fell  of  St.  John's  College,  nor 
am  I  qualified  to  represent  him  in  any  way;  but 
it  strikes  me  that  inasmuch  as  he  has  put  himself 
mi  record  as  favoring  such  an  expansion  of  the 
institution  as  to  include  among  its  departments 
a  school  of  technology,  a  school  of  music  and  a 
school  of  the  fine  arts,  he  can  be  said  to  have 
the  University  idea.  His  other  qualifications 
-peak  for  themselves.  Respectfully  your>. 
Thomas  E.  Satterttiwaite. 
A.B.  (Vale),  AI.D.  (Columbia).  LL.D.  (Uni- 
versity of  Maryland),  Sc.D.  (St.  John's). 


ITEMS 

Prof.  Adolph  von  Bickel  of  the  University  of 
Berlin,  who  is  the  director  of  the  Institute  for 
Experimental  Medicine  associated  with  the  Uni- 
versity of  Berlin,  was  the  guest  of  Prof.  John 
( ',.  I  lemmeter  on  October  4,  5  and  6,  at  his  resi- 
dence, 739  University  Parkway,  Roland  Park. 

I  'rofessor  Bickel  had  been  summoned  to  this 
country  by  .Mr.  J.  Green,  president  of  the  Na- 
tional Biscuit  Company,  to  treat  Mrs.  Green, 
who  was  suffering  from  pernicious  anemia.  He 
also  attended  the  Congress  of  Hygiene  and 
Demography  at  Washington.  He  is  editor  of 
several  German  journals  and  an  investigator  of 
rare  ability.  While  in  this  country  he  delivered 
no  other  address  except  the  one  at  the  University 
of  Maryland  on  October  5. 


Kappa  Psi  Fraternity  held  an  informal  smoker 
at  their  new  home,  242  W.  Hoffman  street,  on 
October  9. 


The  Randolph  Winslow  Surgical  Society  is  now 
upon  a  firm  basis,  and  its  members  are  looking  for- 
ward to  an  exceptionally  prosperous  year. 


Among   the   University   alumni    practicing   in 
Idaho  are: 

Bo — Joshua  T.  Price,  class  of  1868. 
Weiser — Wm.  M.  Mitchell,  class  of  1905. 


The  following  officers  were  elected  by  the 
Junior  Medical  Class :  President,  William  S. 
Walsh ;  vice-president,  James  Furman  Dobson ; 
secretary,  George  Loutrell  Timanus ;  treasurer, 
Clarence  C.  Hoke;  historian, .Alfred  Mordecai. 


The  Phi  Sigma  Kappa  fraternity  have  opened 
their  home  at  1222  Mt.  Royal  avenue. 


Prof.  A.  M.  Shipley  gave  an  interesting  address 
upon  anti-vice  at  the  smoker  tendered  University 
of  Maryland  students  by  Prof.  Howard  A.  Kelly 
of  Johns  Hopkins  Hospital. 


The  Latin-American  Club,  one  of  our  most 
solid  organizations,  at  a  meeting  held  early  in 
October  elected  the  following  officers  :  President, 
J.  M.  Buch,  M.,  '13;  vice-president,  V.  P.  Rei- 


174 


THE    HOSPITAL    BULLETIN 


necke,  D..  '13;  secretary,  Herman  M.  Perez,  M., 
'13;  treasurer,  I.  H.  Fajardo,  M.,  '13;  historian, 
K.  de  Jongh,  D.,  '13. 


The  Freshman  Medical  Class  has  elected  the 
following  officers  for  the  coming  session :  Presi- 
dent, Cecil  Rigbv ;  vice-president,  E.  L.  Bishop; 
treasurer,  G.  1'..  YVilkenson;  secretary,  B.  B. 
Brumbaugh. 


Among  the  University  alumni  practicing  in 
Delaware  are : 

Uelmar — S.  Howard  Lynch,  class  of  1906. 

Dover — Edward  F.  O'Day,  class  of  1890. 

Georgetown — George  Frank  Jones,  class  of 
1889. 

Gumboro  ( R.  F.  D,  Millsboro) — Oliver  A". 
James,  class  of  1906. 

Laurel — William  Thompson  Jones,  class  of 
1895. 

Middleton — Dorsey  W.  Lewis,  class  of  1896. 

Reedy  Island  (Port  Penn  P.  O.) — Lawrence 
Kolb,  class  of  1908,  army  surgeon,  U.  S.  P.  H. 
and  M.  H.  S. 

Wilmington — C.  Anthony  Beck,  class  of  1901, 
1836  W.  4th  street:  Ira  Burns,  class  of  1905,  P. 
R.  R.  Station  ;  Gerald  L.  Dougherty,  class  of  1908, 
1901  Delaware  avenue;  Thomas  H.  Phillips,  class 
of  1907,  624  X.  Franklin  street ;  William  Marshall 
Priest,  class  of  1909,  8th  and  Adams  streets; 
Meredith  Ivor  Samuel,  class  of  1900,  1016  Wash- 
ington street. 


Dr.  Josephus  A.  Wright,  class  of  1881,  has 
resigned  as  superintendent  of  Sydenham  Hos- 
pital, and  has  been  succeeded  by  Dr.  Samuel  T. 
Nicholson,  a  graduate  of  Hopkins  in  1910.  Dr. 
Wright  succeeded  Dr.  Robert  A.  Warner,  class 
of   1895. 


The  Baltimore  and  Ohio  Railroad  Company 
will  build  an  emergency  ward  at  the  University 
Hospital  within  the  next  few  months.  It  will 
be  one  of  the  best  equipped  and  most  modern  in 
the  city.  Dr.  Page  Edmunds  will  be  in  charge 
when  completed.  The  present  ward  H,  on  Greene 
street,  will  be  torn  down  and  remodelled  at  a 
cost  of  $4500  to  $5000  to  meet  this  new  de- 
mand. There  will  be  an  operating-room  com- 
pletely equipped  with  all  the  necessary  emergency 
instruments,  a  special  room  for  the  seriously 
injured  and  a  sun  parlor  and  room  fcr  the  less 


seriously  injured.  At  present  it  is  planned  to 
have  only  those  patients  injured  on  the  Balti- 
more and  Ohio  treated  in  this  ward,  and  will  be 
the  only  one  maintained  by  the  railroad  companv. 


Prof.  Randolph  Winslow  was  given  a  surprise 
on  Tuesday  afternoon,  October  22.  when  a  re- 
ception was  given  in  his  honor  by  the  resident 
physicians  of  the  University  Hospital  in  honor 
of  his  sixtieth  birthday,  which  occurred  on  the 
following  day,  October  23.  When  he  appeared 
before  his  class  he  was  presented  with  a  bouquet 
of  60  American  Beauty  roses,  one  for  each  year 
of  his  age.  Dr.  Winslow  has  taught  at  the  uni- 
versity more  than  39  years. 


Dr.  James  B.  Parramore,  class  of  1909,  of 
Jacksonville.  Fla..  has  decided  to  limit  his  prac- 
tice to  surgery  and  gynecology. 


We  wrote  and  asked  Dr.  Darius  Cleveland 
Absher,  class  of  1909,  of  Mount  Airy,  X.  C,  to 
let  us  know  what  he  had  been  doing  since  he  left 
school.  We  think  his  reply  is  far  better  put  than 
we  could  frame  it.  so  we  reproduce  it  for  the 
benefit  of  our  readers.     He  writes : 

"I  am  willing  to  tell  the  little  there  is  to  tell, 
although  I  am  sure  it  will  not  be  interesting.  The 
first  thing  I  did  after  leaving  the  university  was 
to  'go  up  against'  the  Xorth  Carolina  Board, 
and  I  am  glad  to  say  they  "saw  fit  to  let  me  by." 
I  then  located  at  Xorth  Wilkesboro.  X.  C,  and 
became  associated  as  interne  with  a  small  pri- 
vate hospital  (the  Wilkes  Hospital )  for  about  15 
months,  gaining  some  good  practical  experience, 
and  at  the  same  time  I  was  engaged  in  some 
private  practice  and  'taking  unto  myself  a  better 
half.'  In  the  fall  of  1910  I  went  to  Xew  York, 
where  I  took  courses  in  operative  surgery  at 
the  Xew  York  post-graduate  and  at  Bellevue, 
and  attended  clinics  at  several  other  hospitals  in 
Xew  York,  Philadelphia  and  Baltimore.  In  Jan- 
uary, 191 1,  I  located  in  Mount  Airy,  doing  gen- 
eral practice  and  some  little  surgery,  and  hold 
the  position  of  municipal  health  officer.  I  am 
a  member  of  my  State  Medical  Society  and  of 
the  A.  M.  A. — as  I  think  every  reputable  phy- 
sician should  be. 

"I  am  exceedingly  glad  to  hear  of  the  pro- 
gressive steps  the  University  of  Maryland  is  tak- 
ing— raise  the  standard  higher,  both  in  entrance 
requirements  and  in  better  teaching,  w>  that  e\  cry 


THE    HOSPITAL    BULLETIN 


175 


alumnus  of  the  old  school  may  be  able  to  point 
with  pride  to  our  old  Alma  Mater  and  her  red  nil 
— then  every  alumnus  will  be  glad  to  stand  by 
their  Alma  Mater  and  push  her  still  higher,  but 
then  she  won't  need  it  so  much.  Now  is  her 
hour  of  need  and  I  would  that  every  alumnus 
would  stand  shoulder  to  shoulder,  both  financial- 
ly and  otherwise,  in  pushing  the  old  university 
to  the  front  and  in  making  her  the  peer  of  any 
school  in  America.  I  long  to  see  the  day  when 
the  school  will  be  in  reality  the  State  University 
of  Maryland,  and  supported  and  made  great  as 
such. 

"With  greetings  to  all  of  the  eld  boys,  I  am." 

Dr.  Absher  served  for  one  term  as  vice-presi- 
dent of  his  county  medical  society,  and  while  at 
North  Wilkesboro  was  secretary  and  treasurer 
of  its  county  medical  society,  so  he  has  not  hesi- 
tated to  give  his  time  and  work  to  the  uplifting 
of  his  profession.  His  plea  for  the  university 
is  as  timely  as  it  is  forceful,  and  we  appreciate 
his  spirit  of  love  for  his  Alma  Mater. 


By  request  we  give  the  following  locations  of 
the  class  of  1909: 

Darius  Cleveland  Absher,  Mount  Airy,  N.  C. 

A.  Marvin  Bell;  address  unknown. 

George  E.  Bennett,  1127  Madison  avenue,  Bal- 
timore. 

Clarence  Irving  Benson,  Port  Deposit.  Md. 

William  John  Blake.  Benwood,  W.  Va. 

William  Ward  Braithwaite.  Christobal,  Pan- 
ama. 

Norman  Irving  Broadwater,  Oakland,  Md. 

Maxey  Lee  Brogden,  Swansea,  S.  C. 

Paul  Brown  ;  address  unknown. 

Howard  Barton  Bryer,  Newport,  R.  I. 

Miguel  A.  Buch  y  Portuondo,  Santiago,  Cuba. 

William  S.  Campbell,  Albany,  Mo. 

Arthur  E.  Cannon,  Clifton,  S.  C. 

Arthur  Judson  Cole,  Holbrook,  Mass. 

Clarence  Bythell  Collins,  Calvert,  Md. 

1 '.ranch  Craige,  El  Paso,  Texas. 

Carroll  Augustus  Davis,  Arrington,  Nelson 
county,  Virginia. 

Thomas  Robert  Dougher;  died  Februarv  16, 
1012. 

J.  Ernest  Dowdy,  W'inston-Salem.  N.  C. 

Arthur  Louis  Fehsenfeld,  Forest  Park,  Aid. 

Harry  Baldwin  Gantt,  Jr.,  Millersville,  Aid. 

Robert  H.  Gantt;  died  June  10,  191 1. 


Benjamin  Harrison  Gibson,  403  East  Bolton 
street.  Savannah,  Ga. 

William  Thornwell  Gibson,  Batesburg,  S.  C. 

Thomas  Gilchrist,  151  1  Green  street,  Philadel- 
phia, Pa. 

Julian  Mason  Gillespie,  l*.  S.  P.  H.  S.,  Hono- 
lulu, I  lawaii. 

Edwin  B.  <i la.ll,  98  Emerson  street,  Haver- 
hill, Mass. 

Morris  Baldwin  Green,  Hamilton,  Md. 

Jose  Y.  de  Guzman,  Soto,  Porto  Rico. 

Simon  Wickline  Hill,  Regent,  N.  D. 

Joseph  Ward  Hooper,  James  W  alker  Memorial 
I  lospital,  Wilmington,  N.  C. 

James  A.  Hughes,  Strong,  Pa. 

Preston  Hundley,  Montross,  Va. 

Everette  Iseman.  11  East  Jones  street,  Savan- 
nah, Ga. 

< ieorge  Edward  James,  Newport,  N.  J. 

Charles  Herbert  Johnson,  714  Linden  street, 
Camden,  N.  J. 

Adam  Seanor  Kepple,  1  lannastown,  Pa. 

Howard  Kerns,  Granite  Falls,  A I  inn. 

William  Walter  Kettle,  714  Glesian  street,  Port- 
land, Ore. 

Ralph  Norvel  Knowles,  Hebron,  Maine. 

Edgar  Miller  Long,  Hamilton,  N.  C. 

Samuel  Herman  Long.  1922  East  Baltimore 
street,  Baltimore.  Md. 

Ross  Simonton  McElwee,  Statesville,  N.  C. 

James  Finney  Magraw,  Perryville,  Aid. 

William  E.  Martin,  Roslyn,  Md. 

John  Sanford  Mason,  Whiting  Block.  Albu- 
querque, N.  M. 

James  William  Meade,  Jr..  Fishing  Creek,  Md. 

John  Lindsey  Messmore,  Masontown,  Pa. 

Cleland  G.  Moore,  Schuyler,  Neb. 

James  Leftwich  Moorefield.  Guilford  College, 
N.  C. 

Charles  A.  Neafie,  Blackwell's  Island,  New 
York.  N.  Y. 

John  Standing  Norman,  Bladenboro,  N.  C. 

John  Nelson  Neill  Osburn,  Martinsburg,  W. 
Va. 

James  B.  Parramore,  Jacksonville,  Fla. 

Lytle  Neal  Patrick.  Gastonia,  X.  C. 

Thomas  Alexander  Patrick,  Fayetteville,  Tenn. 

Samuel  Jackson  Price;  address  unknown. 

W'ilmer  Marshall  Priest,  Wilmington,  Del. 

Lynn  J.  Putnam,  Shenandoah.  Iowa. 

William  Gwynn  Queen,  Arlington,  Aid. 

Fred  Wharton  Rankin,  North  Carolina. 


i70 


THE    HOSPITAL    BULLETIN 


Jemil  Abdallah  El  Rassy,  Syria. 

Joel  Cutchins  Rawls,  Franklin,  Ya. 

Budd  Jameson  Reaser,  Martins  Creek,  Pa. 

J.  W.  Ricketts.  Central  avenue  and  32d  street. 
Indianapolis,  Ind. 

John  William  Robertson,  Onancoek,  Ya. 

Harry  M.  Robinson,  2010  Wilkins  avenue,  Bal- 
timore, Md. 

Louis  Hyman  Roddy,  Cameron,  Texas. 

John  T.  Russell,  Eastport,  Aid. 

John  G.  Schweinsberg,  1120  West  Cross  street, 
Baltimore,  Md. 

Andrew  John  Shakhashiri,  Syria. 

Reed  A.  Shankwiler,  Detroit  Tuberculosis  San- 
itarium, Detroit,  Mich. 

Furman  Thomas  Simpson,  Westminster,  S.  C. 

Hugh  W.  Smeltzer,  Creendale,  Ya. 

Claud  C.  Smink.  Lauraville,  Aid. 

Maurice  Isaac  Stein,  531  Cumberland  street. 
Baltimore,  Md. 

Xeal  Summers  Stirewalt,  McConnellsville,  S.  C, 

Charles  Franklin  Strosnider,  Newbern,  N.  C. 

Charles  LeRoy  Swindell,  Black  Creek,  X.  C. 

Asa  Thurston,  Taylorsville,  X.  C. 

Alfred  Chase  Trull,  Haverhill,  Mass. 

Frederick  Henry  Vinup,  1221  Hollins  street. 
Baltimore,  Md. 

Adam  Clark  Walkup,  Mcintosh.  Fla. 

John  Bruce  Weatherly,  Altamahaw,  XT.  C. 

Walter  Franklin  Weber;  address  unknown. 

T.  Hayne  Wedaman,  Pomaria,  S.  C. 

Lehman  W.  Williams,  Statesboro,  Ga. 

R.  Gerald  Willse.  1127  Madison  avenue.  Balti- 
more, Md. 

Eugene  Bascom  Wright.  Hebrew  Hospital, 
Baltimore,  Md. 


The  following  resolutions  were  adopted  and 
ordered  spread  on  the  minutes  of  the  Anne  Arun- 
del County  Medical  Society  at  their  regular  meet- 
ing held  at  Annapolis,  Md.,  Tuesday,  October  8, 
1 9 1 2  : 

"Resolved,  Whereas  God,  in  His  infinite  wis- 
dom, has  chosen  to  remove  from  our  midst  our 
friend  and  fellow-practitioner  of  medicine.  Dr. 
Henry  Roland  Walton  (Universit)  of  Maryland, 
class  of  1850)  ; 

"Resolved,  That  the  Anne  Arundel  County 
Medical  Society  extend  the  family  of  our  deceased 
friend  and  fellow-practitioner.  Dr.  II.  Roland 
Walton,  their  heartfelt  sympathy  in  their  hour  of 
affliction ; 


"Resolved,  That  a  copy  of  these  resolutions  be 

forwarded  to  the  family  of  the  late  Dr.  Walton. ; 

"Resolved,  That  a  copy  of  these  resolutions  be 

published  in  the  official  organ  of  'The  Medical 

and  Chirurgical  Faculty  of  Maryland  ;' 

"Resolved,  That  a  copy  of  these  resolutions  be 
published  in  the  Maryland  Medical  Journal : 

"Resolved,   That  these  resolutions  be  entered 
upon  the  minutes  of  this  meeting,  held  the  eighth 
day  of  October,  1912." 
Respectfully, 

Louis  B.  Henkel,  Jr., 

Secretarv. 


Dr.  Arthur  Dean  Bevan  of  Chicago  was  the 
guest  of  Dr.  Randolph  Winslmv  on  November  7, 
and  while  here  was  entertained  in  the  University 
Hospital,  where  he  met  representatives  from  both 
the  Baltimore  Medical  College  and  the  College  of 
Physicians  and  Surgeons  of  Baltimore. 


A  called  meeting  of  the  executive  committee  of 
the  University  of  Maryland  General  Alumni  As- 
sociation was  held  at  the  office  of  Judge  Dawkins 
on  October  ir.  19,12.  The  following  were  pres- 
ent: Dr.  Charles  E.  Sadtler  (1873),  president; 
James  W.  Bowers,  vice-president;  Flon.  Walter 
I.  Dawkins.  Frank  V.  Rhodes.  John  B.  Thomas, 
Eugene  W.  Hodson,  John  H.  Skeen  and  Dr.  H.  F. 
Gorgas.  Dr.  Nathan  Winslow  was  nominated 
fi  a-  corresponding  secretary  for  the  coming  year, 
nominations  to  be  presented  to  the  meeting  of  the 
Association  on  Academic  Day,  November  12. 
The  directors  nominated  from  the  medical  school 
were  Drs.  St.  Clair  Spruill  11890)  and  Harry 
Adler  (1895).  New  members  were  nominated 
for  the  Advisory  Council,  Drs.  Charles  E.  Sadtler 
1  1873),  E.  F.  Cordell  (1868)  and  Harry  Adler 
1  1805  being  nominated  to  represent  the  meidcal 
school.  The  nominees  were  elected  at  the  meet- 
ing on  November  12  immediately  preceding  the 
annual  banquet. 


■  Academic  Day,  November  12,  1912.  marked  the 
one  hundred  and  twenty-third  anniversary  of  the 
founding  of  St.  John's  College,  the  department  of 
arts  and  sciences  of  the  University.  At  10.30 
o'clock  the  formal  exercises  began  at  Westminster 
Church.  Fayette  and  Greene  streets,  the  St.  John's 
Cadets,  the  University  faculty  and  students  and 
alumni  marching  in  a  body  to  the  church,  lead  by 
the  St.  John's  Band.    The  academic  march — "The 


THE    HOSPITAL    BULLETIN  177 

University  of  Maryland" — was  given  on  the  or-  The  Cross-Country  Club  game,  although  not 

gan  hy  Robert  L.  Haslup,  and  the  invocation  de-  an    Ai    exhibition,    showed    excellent    material, 

livered  by  Rev.  Dr.  Thomas  Grier  Koontz,  pastor  which    after   a   little   practice    should   develop   a 

of  the  church.    The  acting  provost,  Judge  Henry  bright  future. 

Stockbridge,  made  an  address  of  greeting,  fol-  The  lineup  for  the  „ame  was  ag  follows. 

lowed  by  an  address  on  the  life  and  work  of  Her-  ^  ,.                            ...... 

,    „J  „  ,    ,        ,     ,  Kl> Colhson   (captain). 

nard    Carter.    Provost,    and    by    Arthur    George  r,  TT,,                        „     ,    '    f, 

.    .,         .,  •    ,   ,      ....         '  K.J  1.1, Cooley,  Krantz. 

Brown,  and  a  sirmlar  tribute  to    1  ihn  Wirt  Kan-  T  TT  _                                         _ 

,  ,.      .  ,.  ,      ,        ,       ,.    ,  L.H.B Ross. 

dall,  also  a   former  provost  and  who  also  died  -  ., 

during  the  year,  by  Philemon  11.  Tuck.     Dr.  B.  :'                 ........    . . 

",..,.  ,,  „  ,         „    „     ,    lr  L Stephens     manager). 

Merrill  Hopkrason,  Messrs.  Edgar  T.  Paul,  Ho  '                     ,      / 

hart   Smock   and    lohn    11.    Richardson   rendered  .    ,.'                                    ' ' ','    , 

.     .        ,     •        .  _      „  .,    ...  L.ti Blackmore. 

solos    during   the    meeting.      Dr.    r.rnest   /uebhn  _  „                                           __            . 

,  ,'  ....  ,  ,.,.        ,  ™       ,        .,  R.l Kennard. 

made  an  address  on    Aims  of  Clinical   leading,  T  ~                             _      „    „ 

„     r    ,  .      r  L.  1 Dorell,  Bung. 

and  referred  to  the    martyrs     of  the  profession  T  „                                          ,, 

,     ,      .  ,.,.'.  ,  .  L.I'. Rogers. 

who  had    given   their  lives   in  order  to  advance  ..  .,                                           „, 

,.     ,      '   ,  .  _     „     ...         .  ,      ...       ..  K.b. .Murrey. 

medical  teaching.    Dr.  /.uebhn  paid  a  high  tribute 

to  the  medical  men  of  America,  and  said  that  their 

progress  was  being  watched  the  world  over,  and  Manager    II.    II.    Warner    issued    a    call    for 

that  workers  everywhere  are  stimulated  by   the  basket-ball  practice,  which  was  answered  by   15 

achievements  in  medicine  in  America.  men.  but  tw°  of  tht  old  men  turning  out— War- 
ner and  Porter.  A  cracking  good  schedule  will 
be  announced,   including  Loyola,    University  of 

It  was  announced  on  Academic  Day  that  Prof.  Pittsburgh,    Catholic    University,     Carlisle,     St. 

and  Airs.  John  C.  Hemmeter  had  made  a  gift  of  John's  and  others. 

securities  to  the  amount  of  $5000  to  be  applied  to  

the  fund  to  support  the  Hemmeter  chair  of  physi-  .       ,       .     „.                at           1                            -n 

,    .     .     '                        .   ,          ,  Academic  Day  was  November  t_\  1912.     Pro- 

ologv,  bringing  the  amount  of  the  endowment  up  .            ,.,,.:,.          ,    ,          .     .     ,      ,  , 

Z  lessor  /.uebhn  delivered  the  principal  address. 
to  Sio.ooo. 

.                     .  .                 ,       rx   .        .  Among   the   University   alumni    practicing   in 

Among  the   recent  visitors   to   the    University  _  ...       7 

, ,       .    ,'           „                   „    „                                .  California  arc: 
Hospital  were  Drs.  lames  B.  Parramore,  class  ot 

1909,  of  Jacksonville,  Ida. ;  Watson  Smith  Ran-  Bakersfield-Byron  Rees  Rees,  class  of  1900, 

kin,  class  of  1901,  of  Raleigh,  N.  C. ;  Brooke  L.  °ld  Flsh  Budding. 

Jamison,  class  of  1905,  of  Emmitsburg,  Md,  and  Chico— Oscar  Stansbury,  class  of  1873. 

Thomas  Brooks,  class  of  1910,  of  Santiagi  >.  Cuba.  Danville— H.  C.  Reamer,  class  of  1885. 

Los    Angeles — Chas.    Lewis    Allen,    class    of 

1887,    Pacific    Electric    Building;    Frederick    S. 

athletics.  Gate,  class  of  1898,  Nadeau  avenue ;  Josiah  Evans 

A  call  for  football  practice  was  issued  by  Coach  Cowles,  class  of  1880,  American  Bank  Building : 

Willse  and  was  answered  by  a  large  squad,  repre-  Roy  S.  Lanterman.  class  of  1893,  Grosse  Building  ; 

senting  practically  every  department.     The  fol-  Joseph  A.  Le  Doux,  class  of  1889,  McLaughlin 

lowing  dates  were  announced  :  Building;  Wm.  K.  Robinson,  class  of  1893,  610  S. 

Oct.  26 — Cross-Country  Club.     At  home.  Broadway;  Benjamin  Mosby  Smith,  class  of  1888, 

Oct.  if) — Maryland  Agricultural.     At  College  3r4  W.  64th  street. 
Park. 

Nov.  2 — Open.    At  home.  Since  the   advanced  preliminary  requirements 

Nov.  9 — University  of  Pittsburgh.     At  Pitts-  have  gone  into  effect,  Dr.  Coale  informs  us  that  of 

burgh.  about  165  registered  by  the  special  examiner  of 

Nov.  16 — Delaware  College.    At  Delaware.  the  State  Board  of  Medical  Examiners,  Mr.  Otis. 

Nov.  23 — St.  John's.    At  Annapolis.  the  University  of  Maryland  has  matriculated  93. 

Nov.  27— Rock  Hill.    At  home.  or  more  than  half  of  the  total  number. 


i78 


THE    HOSPITAL   BULLETIN 


Among  the  University  alumni  practicing  in 
Massachusetts  are : 

Ashfield — John  Edwin  Urquhart,  class  of  1883. 

Athol — George  J.  Bassow,  class  of  1899. 

1 '.iston — Wm.  Thomas  Councilman,  class  of 
1878,  240  Longwood  avenue;  Richmond  Favour, 
class  of  1904.  2121  Washington  street;  Henry  P. 
Frost,  class  of  1889,  Boston  State  Hospital; 
Woodbury  Dudley  James,  class  of  1881,  82  War- 
ren street;  Chas.  Lusby  Pearson,  class  of  1883, 
427  Marlboro  street ;  Isaac  J.  E.  Shapira.  class  of 
1897,  238  Huntington  avenue;  Harold  Walker, 
class  of  1871,  147  S.  Huntington  avenue;  James 
Homer  Wright,  class  of  1892,  95  Mountfort 
street. 

Brookline — Arthur  Alden  dishing,  class  of 
1904,  108  Marion  street. 

Fall  River — Clarence  W.  Stansfield,  class  of 
[906,  1274  X.  Main  street. 

Foxboro — Irwin  Hoffman  Neff,  class  of  1889. 

Haverhill — Alfred  Chase  Trull,  class  of  1909, 
48  White  street. 

Molbrook — Arthur  Judson  Cole,  class  of  1909. 

Holyoke — John  Joseph  Carroll,  class  of  1905, 
120  Chestnut  street;  George  L.  Kinne,  class  of 
1887,  265  Maple  street ;  Harold  E.  Miner,  class  of 
[905,  51  Maple  street;  Allen  T.  Moulton,  class  of 
!'M  1,  interne  House  of  Providence. 

Lawrence — Walter  Daniel  Riordan,  class  of 
1003,  187  Newbury  street;  Myer  Schwartz,  class 
of  if>02,  261  Common  street. 

Lowell — Charles  Ephraim  French,  class  of 
r893,  Runels  Building;  Arthur  E.  Gillard,  class 
of  1887,  32  John  street ;  Frederick  Augustus  War- 
ner, class  of  1873,  Lowell  General  Hospital. 

Lynn — Elias  Xathanson,  class  of  1908,  242 
Summer  street. 

Northampton — Garrett    J.    Hickey,    class    of 

1893. 

North    Attleboro — Amzi    Beddell    Shoemaker. 

class  of  1908. 

Siiuthbridge  —  William  Stanislaus  Conway, 
class  of  1910. 

Sw  ampscott — Edward  Van  D.  Bray,  class  of 
1894. 

West  Medway — Samuel  Butler,  class  of  1904. 


held  for  the  visiting  members  of  the  fraternity 
at  the  University  Hospital  and  Johns  Hopkins 
on  Saturday.  November  30. 


The  Nu  Sigma  Nu  Fraternity  have  opened 
their  new  home  at  618  West  Lombard  street, 
where  they  are  preparing  for  the  bi-annual  con- 
vention of  the  fraternity  to  be  held  in  Baltimore 
November   29   and   30.      Special   clinics    will   be 


We  regret  exceedingly  to  announce  that  Dr. 
John  Clements  Harris,  class  of  1862,  of  773 
West  Lexington  street,  was  stricken  with  paraly- 
sis on  the  afternoon  of  October  31,  and  his  con- 
dition is  serious.  Dr.  Harris  has  been  living  for 
years  alone  in  the  big  house  on  Lexington  street 
and  was  found  there  alone  and  unconscious.  He 
was  taken  to  a  neighboring  residence  and  his 
only  relative,  a  brother,  James  S.  Harris,  of 
Everett,  Kent  county,  Maryland,  was  notified. 


ENGAGEMENTS 


The  engagement  is  announced  of  Dr.  Elijah 
Emera  Nichols,  class  of  191 1,  of  Pikesville,  Md., 
to  Miss  Caroline  Estelle  Lauer,  daughter  of  Airs. 
Henry  Lauer,  of  Walbrook.  The  wedding  will 
take  place  in  the  early  spring. 


MARRIAGES 

Dr.  Herbert  Jerome  Rosenberg,  class  of  1908, 
of  Atlanta,  Ga.,  was  married  to  Miss  Rosalie 
Loeb,  daughter  of  Mr.  and  Mrs.  Marcus  Loeb. 
Tuesday,  November  5.  1912.  The  ceremonv  took 
place  at  the  home  of  the  bride,  439  Washington 
street,  Atlanta,  and  was  performed  by  Rev.  Dr. 
Marx.  After  a  honeymoon  spent  in  the  North, 
the  couple  will  live  at  409  Washington  street,  At- 
lanta, where  the  Doctor  is  engaged  in  the  practice 
of  his  profession.  Dr.  Rosenberg  is  the  son  of 
Mr.  and  Mrs.  A.  Rosenberg:  of  Greenwood,  S.  C. 


Mrs.  Sovena  Jane  Smith  has  announced  the 
marriage  of  her  daughter.  Miss  Maude  Fowble 
Smith,  University  Hospital  Training  School  for 
Nurses,  class  of  1908,  to  Mr.  Thomas  Reese 
Cornelius,  on  Saturday,  October  26,  1912,  at 
Trinity  Church,  Towson.  Md.  Mr.  and  Mrs. 
Cornelius  will  be  home  after  December  1,  1912, 
Giddings -avenue,  Govans,  Md. 


DEATHS 

Dr.  Robert  Ferguson  Chapman,  class  of  1865, 
who  has  been  in  active  practice  for  almost  50 
years,  died  on  the  morning  of  November  12.  10,12. 
at  his  home,  121  West  120th  street.  New  York. 
Dr.  Chapman  was  born  in  La  Plata,  Md.,  July  24, 


THE    HOSPITAL    BULLETIN 


179 


1S41.  and  was  the  son  of  Gen.  John  Chapman  and 
Susan  Pearson  Chapman,  and  was  descended  on 
both  paternal  and  maternal  side  from  the  early 
English  and  Scotch  settlers  of  .Maryland  and  Vir- 
ginia of  [633  and  [635.  He  studied  at  Charlotte 
I  [all  Academy,  and  later  graduated  at  Yale  with 
the  cla^s  of  [862,  being  the  only  Southerner  in 
the  institution  at  the  time  of  his  graduation.  He 
received  his  A.M.  from  Yale  in  1KO5.  lie  studied 
medicine  for  a  while  at  the  College  of  Physicians 
and  Surgeons  of  Columbia  University,  and  then 
Matriculated  at  the  University  of  .Maryland,  grad- 
uating in  [865.  I  le  settled  in  Southern  Maryland 
and  practiced  there  for  a  while,  moving;  to  New 
York  in  [872.  (  )n  July  12,  1X70,  Dr.  Chapman 
married  M  is-,  Nannie  Duvall  of  Baltimore,  who 
died  two  3  ears  agi  >.  I  le  was  a  member  of  the  Psi 
L'psilon  fraternity  of  Vale  and  of  St.  Andrew's 
I '.  I'..  Church  of  New  York.  Dr.  Chapman  is  sur- 
vived by  one  son,  Robert  Fendall  Chapman,  of 
New  York,  a  graduate  of  the  College  of  Phy- 
sicians and  Surgeons  of  Columbia  University  of 
the  class  of  1895. 


ternity  throughout  the  State  received  the  news 
of  his  death  with  the  utmost  sorrow.  He  is  sur- 
vived by  three  sons  and  three  daughters. 


Dr.  I.  Denham  I 'aimer,  class  of  1872,  of  Jack- 
sonville. Fla.,  died  on  November  3,  1912,  from 
the  effects  of  a  bullet  wound  accidentally  re- 
ceived. Dr.  Palmer  was  in  his  offices  in  the 
Doty  Building  and  had  as  a  patient  a  young  man 
who  lived  some  distance  from  the  office,  and 
who  carried  the  pistol  as  a  method  of  protection 
because  of  the  present  unrest  in  Jacksonville. 
After  Dr.  Palmer  had  finished  his  examination 
the  patient  drew  his  coat  across  the  table  to  put 
it  on  and  the  pistol  was  thrown  to  the  floor.  It 
struck  at  such  an  angle  that  the  instant  discharge 
sent  the  bullet  into  Dr.  Palmer's  thigh,  from 
whence  it  glanced  upward  through  his  body.  1  >r. 
Palmer  was  rushed  to  St.  Luke's  Hospital  in- 
stantly, this  being  about  2  P.  M.,  but  he  died  at 
7.30  P.  M. 

Dr.  Palmer  was  born  in  Monticello.  and  be- 
longed to  one  of  Florida's  oldest  and  most  aris- 
tocratic families,  lie  attended  the  public  schools 
of  Florida  and  then  matriculated  at  the  univer- 
sity, from  whence  he  was  graduated  in  1872. 
He  practiced  in  Fernandina  until  1905.  when  he 
removed  to  Jacksonville.  He  did  yoeman  service 
in  the  work  of  conquering  and  stamping  out  yel- 
low fever  during  the  epidemic  in  Jacksonville, 
Memphis,  Tenn..  and  Fernandina,  Fla.  He  was 
respected  and  loved  by  all,  and  the  medical  fra- 


BOOK  REVIEWS 
[international  Cunics.     A  Quarterly  of  Illus- 
trated Clinical  Lectures  and  Especially   Pre- 
pared  Lectures;   Prepared  Original    Articles 
on   Treatment,    Medicine,    Surgery,    Neurol- 
ogy,     Pediatrics,     (  )bstetrics.     Gynecology, 
Orthopedics,  Pathology,  Dermatology,  Oph- 
thalmology,  <  Hology,   Rhinology,   Laryngol- 
ogy and   <  )ther   Topics   of   Interest  to   Stu- 
dents and    Practitioners.     P>y  leading  mem- 
bers of  the  Medical  Profession  throughout 
the    world.      Edited   by    1  lenry   \V.    Cattell. 
A.M.,  M.D.,  Philadelphia,  U.  S.  A.     With 
the  collaboration  of  John  A.   Witherspoon, 
M.D.,     Nashville,    Tenn.;    William    Osier, 
M.D.,  Oxford;  A.    McPhedran,   M.D.,  To- 
ronto ;     Frank     Billings.     M.D.,     Chicago ; 
Charles  II.  Mayo,  M.D.,  Rochester;  Thomas 
H.    Rotch,    M.D.,    Boston;   John    G.    Clark, 
M.D.,  Philadelphia;  James  J.  Walsh.  M.D.. 
New  York;  J.  W.   Ballantyne,  M.D.,  Edin- 
burgh; John  Harrold,  M.D.,  London;  Rich- 
ard   Kretz,    M.D.,    Vienna.      With    regular 
correspondents  in  Montreal,  London.  Paris, 
Berlin,  Vienna,  Leipsig,  Brussels  and  Carls- 
bad.    Volume    III;     twenty-second    series; 
1912.     Philadelphia  and  London:  J.  B.  Lip- 
pincott  Company.  Cloth  ;  $2  net. 
Prof.  Theophilus  Ciesielski  in  his  paper,  "I low- 
It  Happens  That  the  Offspring  of  Plants,  Ani- 
mals  and   Men   is   Sometimes   Male,    Sometimes 
Female,"  opens  the  old,  old  question ;  the  riddle 
of    many    ages.      He    states :      "After   studying, 
year  by  year,  from  1871  onward,  the  question  of 
the  origin  of  sex  in  cannabis  sativa,  I  discovered 
in  1878  an  unchanging  and  settled  law  of  nature, 
in  accordance  with  which  it  happens  that  some- 
times male  cannabis  plants  and  sometimes  female 
ones  are  produced,  so  that  if   we  keep  the  law 
clearly   in   view   we   can   in   very   simple   fashion 
control   this  enigma  of  nature.      For  33  years  I 
have  hesitated   whether  I   ought  to  publish  this 
law  of  nature ;  for  I  feared  that  the  knowledge 
of  it  would  tend   to  lower  the  moral  standard, 
but  now  at  length  I  am  satisfied  that  I  ought  not 
to  delay,   for  it  may  well   happen  that   someone 
else  may  not  hesitate  to  make  this  same  discovery 
public." 


i8o 


THE    HOSPITAL    BULLETIN 


Whether  the  conclusions  drawn  are  true  or 
not,  the  article  shows  the  result  of  careful,  pains- 
taking, scientific  investigation  extending  over  a 
number  of  years,  and  that  the  theory  is  not  hastily 
concocted.  After  years  of  experimentation  upon 
the  cannabis  plant  with  ineffectual  results,  Dr. 
Ciesielski  noted  finally  that  female  plants  impreg- 
nated with  fresh  pollen  produced  male  plants ; 
female  plants  dusted  with  stale  pollen  produced 
female  plants.  Not  satisfied  that  he  had  entirely 
solved  the  question,  the  author  also  investigated 
the  problem  in  animals  with  the  same  results.  He 
noticed  that  a  doe  rabbit  served  once  only  by  a 
buck,  which  had  not  had  connection  for  some 
days,  produced  a  litter  of  two  or  three  females, 
but  if  a  buck  was  used  which  had  had  connec- 
tion the  day  before,  then  she  would  bear  two  or 
three  males.  He  states  that  he  has  proved  the 
truth  of  this  law  in  horses,  dogs,  cattle  and  man. 

If  the  observations  prove  true,  the  author  has 
made  the  world  his  debtors.  At  any  rate,  true 
or  not  true,  his  labors  should  be  an  incentive  to 
others  not  alone  in  this  field,  but  also  in  every 
line  of  medical  research.  It  is,  indeed,  a  rarity 
that  we  see  a  man  in  these  times  holding  back 
any  investigation  and  testing  its  value  over  such 
an  extended  period  of  time.  Another  paper  well 
worth  while  is  "The  Modern  Treatment  of 
Gout,"  by  Marcel  Labbe,  M.I).  '"The  Diagnosis 
and  Treatment  of  Locomotor  Ataxia,"  by  Wil- 
liam J.  Maloney,  should  interest  the  readers  of 
the  "Clinics."  Besides  the  articles  mentioned 
above,  there  are  a  number  of  others  which  con- 
cern pertinent  topics  of  the  day.  Taken  all  in 
all,  the  present  number  is  the  best  resume  of 
modern  problems  in  medicine. 


Internal  Medicine.  By  David  Bovaird.  Jr.. 
A.B.,  M.D.,  Assistant  Professor  of  Clinical 
Medicine  in  the  College  of  Physicians  and 
Surgeons  of  Columbia  University,  Associate 
Visiting  Physician  of  the  Presbyterian  Hos- 
pital and  Visiting  Physician  of  the  Seaside 
Hospital  in  the  City  of  New  York.  With 
109  illustrations  in  the  text  and  seven  col- 
ored plates.  [912.  Philadelphia  and  Lon- 
don: T-  B.  Lippincott  Company.  Cloth ;  $5 
net. 

<  >ne  is  surprised  that  after  extracting  the  ma- 
terial   of   the    specialties,   so    much   still    remains 


which  may  be  delegated  to  the  domain  of  internal 
medicine.  Still  it  seems  highly  improbable  that 
this  divorcing  can  or  will  be  followed  much 
further.  The  tendencies  of  the  times  should  be 
and  no  doubt  will  be  the  restoral  of  much  to  in- 
ternal medicine  which  has  been  turned  over  to 
the  specialties.  However,  even  with  the  present 
and  past  aggressions,  there  is  yet  enough  left  to 
demand  serious  attention.  In  fact,  internal 
medicine  is  the  framework  upon  which  the  stu- 
dent builds  his  knowledge  of  the  entire  field  of 
medicine,  and  if  he  is  not  well-grounded  in  its 
essentials,  he  will  always  be  handicapped  in  his 
after  work.  With  the  numbers  of  good  prac- 
tices of  medicine  on  the  market,  another  would 
seem  worthless,  and  at  first  glance  the  reviewer 
would  coincide  with  this  view.  Writing  a  book 
for  students,  however,  is  a  difficult  task,  and 
most  of  the  books  on  the  market  are  either  too 
cumbersome  for  their  purposes  or  too  skimpy. 
What  students  desire  is  an  authorative  book,  de- 
void of  statistical  compilations  and  debatable 
theories.  They  desire  facts  stated  dogmatically. 
If  the  subject  under  discussion  is  dealing  with 
debatable  matter,  they  desire  the  most  likely 
hypothesis  and  nothing  more.  Such  a  volume  is 
Bovaird's  "Internal  Medicine."  It  covers  the 
field  thoroughly  and  in  a  most  satisfactory  man- 
ner. We  are  particularly  impressed  with  the 
manner  in  which  the  writer  approaches  the  hand- 
ling of  matter  which  other  authors  take  for 
granted  is  known;  for  instance,  the  minute  and 
detailed  manner  in  which  he  describes  the  tech- 
nic  of  paracentesis.  We  are  also  gratified  to  note 
the  number  and  quality  of  illustrations  included 
in  the  text ;  a  feature  only  too  much  neglected 
by  most  writers  on  internal  medicine.  Mechan- 
ical aids  in  the  study  of  disorders  of  the  circula- 
tion have  become  so  perfected  that  every  stu- 
dent before  graduating  should  be  absolutely  con- 
versant with  the  use  of  the  various  appliances. 
A  chapter  on  this  subject  should  interest  students 
in  the  knowledge  to  be  thus  obtained.  Syphilis, 
as  it  rightly  should,  has  been  included  among 
those  diseases  due  to  animal  parasites.  Taken 
all  in  all,  the  book  is  admirably  adapted  to  stu- 
dent purposes,  being  extremely  well  propor- 
tioned, neither  too  fulsome  nor  too  meager.  Its 
many  good  qualities  should  command  it  an  early 
popularity. 


THE  HOSPITAL  BULLETIN 

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THE    HOSPITAL    BULLETIN 


A   SUMMER  CRUISE  ON   THE  SPANISH 
MAIN. 


By  Randolph  Winslow,  M.D. 


4.       COSTA  RICA   AND  SANTIAGO  DE   CUBA. 

One's  preconceived  ideas  of  geography  are  apt 
to  be  very  much  upset  by  actual  travel.  I  had  sup- 
posed Costa  Rica  to  be  situated  due  north  of 
Colon;  but,  as  a  matter  of  fact,  one  sails  almost 
due  west  to  reach  Port  Limon,  the  only  seaport 
on  the  Atlantic  side  of  this  Central  American  re- 
public. Leaving  Colon  at  2  P.  M.,  we  reached 
Port  Limon  about  8  o'clock  the  next  morning. 


Having  been  duly  lined  up  and  examined,  and 
found  free  of  cholera,  yellow  fever,  smallpox  and 
bubonic  plague,  we  were  permitted  to  tempt  fate 
by  jumping  into  a  rowboat  when  it  rose  on  the 
crest  of  a  wave  and  rowing  ashore.  Port  Limon 
is  an  unattractive  town  of  5000  inhabitants.  There 
is  a  small  but  pretty  park,  with  the  customary 
bandstand  in  its  center.  The  houses  are  mostly 
of  frame  construction,  and  are  not  ornamental. 
The  United  Fruit  Co.  is  the  most  important  factor 
in  the  life  of  the  town,  and,  indeed,  in  the  finan- 
cial and  commercial  affairs  of  the  country.  This 
company  maintains  good  lines  of  steamships  ply- 
ing between  New  Orleans  and  Costa  Rica,  as  well 
as  between   New  York  and    Port   Limon.     The 


,  No.   193     Puntarenas 


C**-"*  /UAt 


PTJNTABENAS,    COSTA    RICA. 


Some  ships  put  in  at  Bocas  del  Toro.  which  is  a 
thriving  town  at  the  extreme  northern  part  of 
Panama,  to  load  bananas,  but  our  itinerary  did 
not  call  for  a  stop  at  that  place.  There  is  no  har- 
bor at  Port  Limon,  but  an  open  roadstead,  which 
is  both  uncomfortable  and  dangerous.  Ships  can 
dock  at  the  piers  in  good  weather,  but  during 
storms  they  must  cast  loose  and  put  to  sea  or  seek 
protection  behind  an  island.  Fortunately,  we  were 
favored  with  fairly  pleasant  weather,  though  the 
water  was  by  no  means  smooth.  As  much  for- 
mality is  observed  on  entering  port  in  one  of  these 
bantam  republics  as  is  customary  in  the  large  sea- 
ports of  the  Great  Powers.  The  flag  of  the  coun- 
try is  run  to  the  head  of  the  foremast,  and  when 
the  quarantine  and  customs  officers  approach  the 
band   plays   the   national   hymn   of   the   country. 


banana  trade  is  almost  entirely  in  the  hands  of  the 
United  Fruit  Co.,  though  the  Atlantic  Fruit  Co. 
also  exports  this  fruit  in  smaller  quantities.  Costa 
Rica  is  a  mountainous  country  of  23,000  square 
miles  area,  with  a  population  of  390,000.  The  in- 
habitants are  less  mixed  in  character  than  are 
those  of  the  other  Central  American  countries, 
and  are  mostly  of  pure"  Spanish  origin.  On  the 
coast  there  is  a  considerable  number  of  West  In- 
dian negroes,  who  are  in  the  employ  of  the  fruit 
companies,  but  in  the  interior  the  people  are  white, 
with  some  admixture  with  Indian  blood.  Landing 
at  Port  Limon,  and  passing  inspection,  the  next 
thing  to  do  is  to  get  American  money  changed 
into  that  of  Costa  Rica.  The  colone  is  the  na- 
tional unit  of  currency,  being  equivalent  to  about 
44  cents  in  our  money.    A  narrow-gauge  railroad 


THE    HOSPITAL    BULLETIN 


183 


runs  from  Limon  to  San  Jose,  the  capital,  about 
103  miles,  but  only  one  train  leaves  daily  from  each 
terminus.  For  the  first  20  miles  the  road  traverses 
a  Hat,  jungle-covered,  swampy  region,  sparsely 
settled  with  negroes,  whose  shanties  are  collect  I 
here  and  there  into  miserable-looking  villages. 
The  negroes  appear  to  be  the  same  happy-go- 
lucky  people  that  we  find  in  our  own  Southern 
Stales,  and  here  and  there  the)  were  seen  dancing 
and  making  merry  to  the  music  of  some  broken- 
down  instrument.  Soon  we  were  ascending  the 
mountains,  ever  increasing  in  altitude,  until  6003 
feet  is  reached.  The  ride  over  the  mountains  is 
very  beautiful.  In  many  places  broad  highland 
valleys,  with  cultivated  fields,  are  seen,  or  pasture 


delayed  by  a  landslide.  Costa  Rica  is  a  land  in 
which  earthquakes  arc  of  frequent  occurrence, 
and  our  route  passed  through  Cartago,  formerly 
a  town  of  15,000  population,  which  was  almost 
completely  destroyed  about  two  years  ago,  it  has 
been  partially  rebuilt  with  one-story  concrete 
bouses,  but  there  are  still  many  vacant  -pots,  and 
many  others  on  which  only  rude  shacks  arc  lo- 
cated. Andrew  Carnegie's  palace  for  the  Central 
American  Court  was  situated  in  this  town,  ami 
was  also  destroyed.  1  understand  it  will  be  re 
built  at  San  Jose.  A  statue  of  a  former  President 
was  turned  completely  around,  so  that  it  faces  in 
the  opposite  direction  to  that  in  which  it  was  orig- 
inally placed.    Descending  from  Cartago  11  miles, 


Vista  del  Campo     C.  K 


VISTA    DEL    CAMPO,    COSTA    RICA. 


lands  on  which  herds  of  cattle  and  other  stock 
were  contentedly  grazing.  The  steep  sides  of  the 
mountains  were  covered  with  coffee  bushes,  where 
they  could  get  the  sunshine  and  rain.  The  coffee 
industry  is  one  of  the  chief  sources  of  revenue  of 
the  people.  They  claim  that  Costa  Rican  coffee 
is  the  best  in  the  world,  but  the  coffee  I  drank 
was  about  the  worst  I  had  ever  tasted.  Rut  per- 
haps I  was  not  sufficiently  educated  to  appreciate 
it.  One  disadvantage  in  traveling  by  rail  in  this 
country  is  the  frequent  landslides  and  washouts 
that  occur,  so  that  one  can  never  tell  when  he  goes 
into  the  interior  whether  he  will  be  able  to  get 
back  again  in  any  reasonable  time.  W'e  were  as- 
sured that  there  would  be  no  such  catastrophe 
during  our  visit,  as  it  only  occurred  later  in  the 
year;  nevertheless,  a  few  davs  later  the  train  was 


we  come  to  San  Jose,  situated  on  a  plateau  5000 
feet  above  sea  level.  The  situation  is  beautiful — 
almost  like  a  huge  amphitheater  surrounded  by 
mountain  ranges.  The  city  is  attractive  in  ap- 
pearance, with  low  houses  of  Spanish  type,  tinted 
in  varying  colors.  The  streets  are  rather  narrow, 
but  are  fairly  well  paved  and  are  kept  clean. 
Trolley  lines  run  in  several  directions,  and  there 
is  considerable  bustle  in  the  streets,  with  carriages 
numerous  and  cheap,  drawn  by  good  horses.  Oc- 
casionally one  of  the  heavy-wheeled  carts,  drawn 
by  slow-moving  oxen,  rumbles  by.  The  yoke  does 
not  rest  on  the  neck,  as  with  us,  but  is  attached 
to  the  horns,  and  the  driver  guides  his  team  with 
.1  goad,  with  which  he  strikes  them.  Buzzards  sit 
upon  the  roofs  of  the  houses  and  wander  about 
the  streets,  and  doubtless  they  are  important  mem- 


iS4 


THE    HOSPITAL    BULLETIN 


hers  of  the  street-cleaning  department.  These 
birds  are  black,  but  have  lead-colored  heads,  and 
differ  in  appearance  from  the  turkey  buzzard  of 
the  temperate  zone.  We  secured  rooms  at  the 
Imperial  Hotel,  which  is  imperial  only  in  name. 
The  accommodations  were  crude  and  the  fare 
poor.  Early  breakfast,  from  6  to  7.30,  consisted 
of  poor  coffee,  rolls  with  bad  butter  and  two  eggs. 
Late  breakfast,  12  to  1,  was  really  a  lunch  of  soup, 
one  meat,  vegetables  and  dessert,  and  dinner,  6  to 
7.  was  about  the  same  as  lunch.  None  of  the 
food  was  good,  but  some  was  not  as  bad  as  the 
rest.  One  of  the  great  needs  of  all  these  Central 
American  cities  is  decent  hotels.  Even  in  ( luate- 
mala  City  the  hotel  accommodations  are  very  in- 


and  other  objects,  made  by  the  ancient  Indians 
and  exhumed  from  their  graves.  The  Presiden- 
tial Palace  is  an  unpretentious  building,  one  story 
in  height,  with  two  handsome  reception-rooms, 
furnished  in  red  and  gilt.  I  only  suspected  it  to 
be  the  Presidential  residence  from  the  fact  that  a 
sentry  was  on  guard  in  front  of  the  building. 
There  is  but  little  militarism  in  Costa  Rica,  the 
standing  army  consisting  of  only  500  men.  They 
say  they  have  no  need  of  an  army,  as  Uncle  Sam 
will  not  let  them  fight,  and,  besides,  they  are  too 
busy  to  engage  in  warfare. 

The  Hall  of  Congress  is  situated  across  the 
street  from  the  Imperial  Hotel,  and  is  a  very  nice 
and  well-furnished  room.     We  were  courteously 


Arbol  de  la  V 


Alillol,    UK    1A    TAX.      PEACE    TREE. 


different.  Strange  to  say,  the  Theatro  Nacional 
in  San  Jose  is  one  of  the  most  magnificent  theaters 
in  the  two  Americas,  and  there  is  probablv  no 
playhouse  in  the  United  States  that  compares  with 
it  in  beauty.  We  heard  a  poor  performance  of 
Lucia  di  Lammermoor  by  an  Italian  juvenile  com- 
pany, liven  if  the  singing  was  rather  indifferent, 
at  least  one  had  the  opportunity  to  see  the  fash- 
ionable life  of  this  little  republic.  People  here  ap- 
pear very  much  as  they  are  in  other  civilized  coun- 
tries; the  ladies  were  dressed  in  the  latest  fash- 
ions, and  many  of  them  were  very  attractive  in 
appearance.  The  gentlemen  were  good-looking, 
tin  mgh  rather  swarthy,  and  were  in  conventional 
dress.  There  is  a  National  Museum,  with  a  good 
collection  of  Indian  pottery  and  implements,  and 
-nme   remarkable  sold   figures   of   animals,   bells 


received  by  the  Speaker  and  members  of  Con- 
gress, who  expressed  great  interest  in  the  ap- 
proaching Presidential  election  in  the  United 
States.  There  is  a  large  and  substantial  cathe- 
dral, as  well  as  several  churches  in  the  city,  which 
have  been  more  or  less  damaged  by  earthquakes. 
The  Latin-American  peoples  are  music-loving 
and  light-hearted  ;  they  like  to  walk  around  the 
little  parks,  listening  to  the  excellent  bands  and 
casting  admiring  glances  at  the  girls.  The  girls 
are  pretty,  and  wear  their  hair  down  the  back  or 
tied  behind  the  neck  with  a  ribbon  matching  in 
color  the  inevitable  silk  shawl  that  is  worn  around 
the  shoulders.  A  girl  may  go  barefooted,  but  she 
wears  a  silk  shawl  over  her  shabby  dress.  We 
were  fortunate  in  being  invited  to  visit  the  home 
of  a  prominent  gentleman  and  lady  on  the  out- 


THE    HOSPITAL    BULLETIN 


[8: 


skirts  of  the  city,  and  to  obtain  some  idea  of  the 
home  life  of  the  better  class  of  the  people.  This 
home  is  a  typical  Spanish  house,  of  only  one  story, 
surrounding  an  open  court  or  patio,  in  which  were 
flowers  and  shrubbery  and  a  rare  collection  of 
tropical  birds,  while  in  the  surrounding  grounds 
were  almost  a'll  kinds  of  tropical  fruits  and  vege 
tables.  The  question  is  often  asked.  Is  the  climate 
\i'i\  hot?  In  the  central  elevated  portions  of 
Central  America  the  climate  is  cool  and  bracing, 
but  on  the  coast  it  is  hot  and  debilitating.  At  San 
Jose  light  wraps  and  overcoats  were  very  com- 
fortable after  dark.  Daylight  ends  suddenly  and 
night  sets  in.  There  is  no  twilight,  as  in  more 
northern  countries.     A  very  noticeable  character- 


sailed  for  Colon  on  the  return  voyage.  At  Limon 
we  took  on  50  huge  sea  turtles  destined  to  Eu- 
rope. Two  of  them  died  before  reaching  Colon. 
They  are  placed  on  their  backs  and  are  unable  to 
turn  over.  We  also  took  on  a  motley  deck  load 
of  Jamaican  negroes — men.  women  and  children 
— who  lived,  ate  and  slept  on  the  open  deck  for 
three  days  and  nights.  Many  of  them  were  sea- 
side, and  they  must  have  suffered  intensely,  but 
they  got  off  at  Kingston  as  lively  as  rabbits.  We 
only  stopped  a  few  hours  at  Colon,  and  then  put 
out  across  the  Caribbean  Sea  to  Kingston.  We 
stayed  here  24  hours,  taking  on  a  cargo  of 
bananas,  and  as  it  was  a  holiday  to  celebrate  the 
emancipation  of  the  slaves,  the  stores  were  closed 


CALLE    DEL    PADRE    PICO-PADRE    PICO    STREET. 


istic  of  the  people  is  their  uniform  politeness — 
from  the  Speaker  of  Congress  to  the  policemen 
we  were  treated  with  marked  courtesy.  A  visit 
to  the  market  was  interesting,  though  perhaps  not 
very  appetizing.  San  Jose  is  situated  nearly  mid- 
way between  the  two  seas,  and  has  an  inter- 
oceanic  railroad  connection.  The  Pacific  slope  is 
more  populous  and  more  prosperous  than  the  At- 
lantic side  of  the  country.  Coffee  is  the  standard 
product  on  the  west,  as  bananas  are  on  the  east. 
Doubtless  the  country  is  largely  undeveloped,  and 
will  become  a  more  important  center  as  American 
capital  and  industry  is  attracted  to  a  larger  de- 
gree. 

From  San  Jose  I  retraced  my  steps  toward--  the 
coast,  arriving  without  mishap  at  Port  Limon, 
where,  after  an  uninteresting  stay  of  24  hours,  we 


and  there  was  nothing  to  do.  Early  the  next 
morning  we  were  approaching  the  Cuban  coast, 
and  soon  thereafter  the  grim  walls  of  Morro  Cas- 
tle came  into  view.  The  entrance  to  the  harbor 
of  Santiago  de  Cuba  is  very  narrow,  only  a  few 
hundred  feet  wide,  and  two  ships  cannot  pass 
abreast.  Morro  Castle  is  an  ancient  fortification 
situated  on  a  bluff  overlooking  the  entrance  and 
absolutely  dominating  it.  It  is  now  practically 
dismantled,  and  is  not  formidable  as  a  defense. 
From  the  sea  the  city  is  not  visible,  and  it  is  only 
after  traversing  a  narrow  and  crooked  channel 
that  ships  enter  a  considerable-sized  bay,  and  the 
town  is  seen  situated  at  its  upper  end.  As  the 
narrow  entrance  is  easily  defended  by  means  of 
earthworks  and  torpedoes,  we  can  readily  under- 
stand why  Sampson  did  not  risk  his  ships  in  an 


[86 


THE    HOSPITAL    BULLETIN 


attempt  to  force  the  passage ;  and  if  Hobson  had 
succeeded  in  sinking  the  Merrimac  across  the 
channel  instead  of  on  the  edge  of  it,  the  Spanish 
ships  would  have  been  bottled  up.  The  harbor, 
with  its  islands  and  heavily-wooded  hillsides,  is 
very  picturesque,  and  the  city,  with  its  varicolored 
buildings,  is  like  a  signet  in  a  ring.  The  bay  is 
rather  shallow,  and  ships  must  anchor  at  some 
distance  from  the  shore,  though  some  of  the 
smaller  ones  dock  at  the  wharves.  Drs.  Brooks 
and  Miranda  kindly  came  out  to  meet  us  and  took 
us  ashore  in  Dr.  Brooks'  motor-boat.  They  then 
took  us  an  auto  ride  through  the  city  and  as  far 
as  the  Treaty  Tree,  where  the  capitulation  of  the 
city  took  place  in  1898.  San  Juan  Hill  could  be 
seen  at  a  little  distance,  but  our  time  was  so  lim- 
ited we  could  not  visit  it.  Santiago  is  an  at- 
tractive-looking city  of  Spanish  type,  with  low 
houses  and  narrow  streets  within  the  city,  and 
with  beautiful  villas  in  the  suburbs.  The  location 
is  hilly  and  the  houses  rise  in  tiers,  so  that  from 
many  of  them  a  beautiful  view  of  the  harbor  is 
had.     The  negro  insurrection  had  only  recently 


been  suppressed  and  many  troops  were  quartered 
in  the  city.  A  company  of  infantry  marched  past 
to  embark  for  Havana,  looking  very  much  like 
United  States  regulars.  It  is  said  that  6000  ne- 
groes revolted,  and  that  5000  were  killed  and 
1000  taken  prisoners.  In  consequence  of  this  in- 
surrection several  thousand  United  States  ma- 
rines were  sent  to  the  island,  and  as  we  came  up 
the  coast  we  passed  a  transport  rilled  with  them 
returning  home.  It  is  a  great  regret  to  me  that 
I  could  not  land  when  T  was  in  Santiago  harbor 
nil  July  18,  and  an  equal  disappointment  that  our 
captain  would  only  allow  us  two  hours  on  our  sec- 
ond visit.  My  sincere  thanks  are  extended  to  the 
University  of  Maryland  men  who  did  their  best 
to  entertain  us  on  both  occasions.  About  40  miles 
from  Santiago  is  Guantanamo  Bay,  a  large  sheet 
of  deep  water,  which  is  a  United  States  naval  sta- 
tion. Passing  Cape  Maysi,  we  left  the  Caribbean 
Sea,  and  after  four  days  of  pleasant  sailing  on  the 
Atlantic  Ocean  we  sighted  land  near  Barnegat 
Light,  and  passing  along  the  electrically-illumi- 
nated New  Jersey  coast,  dropped  our  anchor  in 
New  York  Bay  on  August  6  at  11  P.  M, 


THE    AIMS    OF    CLINICAL    TEACHING    TX    MEDICINE. 


By  Ernest  Zuetslin,  M.D., 
Professor  of  the  Principles  and  the  Practice  of  Medicine,  University  of  Maryland,  Baltimore. 


Our  academic  pageant  must  certainly  leave  a 
vivid  impression  upon  the  spectators  and  must 
show  to  the  world  the  realization  of  the  principles 
"cresat,  floreat,  et  fructat"  of  our  Alma  Mater. 
To  the  members  of  our  communion,  however, 
Academic  Day  has  a  far  different  meaning;  it 
is  the  visible  sign  of  our  strength  and  union 
in  the  interests  and  in  the  progress  of  our  in- 
stitution dedicated  to  spread  culture  and  scien- 
tific knowledge  among  our  nation.  The  view  of 
such  a  distinguished  assembly  alone  already  con- 
veys to  the  mind  the  sensation  of  happiness  in 
belonging  to  the  medical  faculty  of  such  a  re- 
nowned University. 

If  on  this  occasion  we  miss  the  late  Provost, 
Bernard  Carter,  and  John  Wirt  Randall,  both 
members  of  the  Board  of  Regents,  whose  activities 
in  the  interests  of  our  Alma  Mater  we  cannot  but 
appreciate,  still  we  feel  ourselves  united  with  the 
spirit  of  the  departed  and  with  the  memory  of  all 
the  men  who  have  contributed  to  the  glory  of  our 


school.  With  reference  to  their  aims,  with  refer- 
ence to  our  present  duties,  we  recognize  the  obli- 
gation to  contribute  our  best  to  the  progressive 
evolution  of  the  University  of  Maryland.  View- 
ing this  assembly  one  realizes  the  great  responsi- 
bility of  preparing  the  student  for  his  practical 
and  professional  duties  and  assuring  him  the 
greatest  benefit  from  his  studies.  The  teacher 
must  start  with  a  clear  conception  of  the  course 
to  follow,  and  must  be  familiar  with  the  means  at 
his  disposal  in  order  to  make  his  task  successful. 

In  a  country  like  the  United  States,  where 
everything  is  in  full  development  and  the  work 
accomplished  in  the  different  universities  proves 
the  continuous  growth  towards  perfection,  the 
task  of  the  professor  of  the  practice  of  medicine 
becomes  very  important  and  attractive.  The 
American  medical  institutions,  encouraged  by  tin- 
financial  support  of  broadminded  donors,  are 
trying  to  give  their  students  the  very  best  instruc- 
tion and  to  offer  them  splendid  material  for  their 


THE    HOSPITAL    BULLETIN 


,87 


clinical  and  practical  training.     The  methods  of 

medical  instruction  in  these  institutions  is  based 
on  the  heritage  of  scientific  knowledge  of  pre- 
vious centuries,  and  shows  a  wonderful  improve- 
ment, arousing  the  interest  and  admiration  of  the 
universities  in  the  old  country.  Just  as  the  splen- 
did invention  of  Marconi  has  overcome  space,  so 
human  intelligence  makes  the  whole  world  akin, 
so  medical  science  finds  its  way  everywhere, 
American  medical  science  and  research  is  red  >g- 
nized  as  a  very  important  factor  in  the  untiring 
fight  against  disease,  and  its  accomplishments 
exert  an  attractive  influence  on  the  graduates  of 
European  universities.  In  increasing  numbers 
foreign  doctors  wishing  to  complete  their  studies 
come  to  American  universities,  and  when  they 
return  to  their  mother  country  they  take  pleasure 
in  reporting  to  their  colleagues  the  creditable 
work  they  have  witnessed  on  their  way  from  east 
to  west  through  the  continent  of  unlimited  pos- 
sibilities. Broadminded  men,  taking  so  much  in- 
terest in  the  successful  growth  of  the  American 
universities,  however,  are  always  busy  finding  new 
means  for  better  instruction.  Comparison  with 
the  methods  of  foreign  centers  of  learning  leads 
them  to  adopt  new  ideas  for  harmonious  co- 
operation among  their  teachers  and  so  to  increase 
the  practical  benefits  of  a  thorough  and  systematic 
training  of  the  students.  It  is  remarkable  to 
watch  this  work,  accomplished  in  such  a  short 
time,  and  American  universities  can  be  proud  of 
their  showing  in  competition  with  foreign  insti- 
tutions. So  the  medical  profession  by  its  knowl- 
edge, its  thorough  experience,  will  add  to  the  glory 
of  the  American  nation.  Among  the  prominent 
facts  of  American  medical  accomplishments  I  can 
mention  only  a  few  :  the  world-wide  reputation  of 
the  Rockefeller  institution  for  medical  research. 
whose  investigations  have  contributed  so  much  to 
our  present  knowledge ;  the  energy  shown  in  the 
fight  against  the  white  plague ;  the  work  of  sani- 
tation pursued  in  transforming  pest  and  plague- 
ridden  cities  into  the  most  healthful  and  delightful 
cities  of  the  world,  Havana,  for  instar.ee;  ar;  ac- 
complishment we  owe  to  the  ingenious  work  of 
Gen.  Leonard  Wood.  At  the  present  time  we 
notice  with  satisfaction  a  well  organized  army  of 
philanthropists  and  eminent  scientific  men  arrayed 
in  the  bloodless  battle  against  human  suffering 
and  disease  instead  of  the  old-time  bloody  con- 
quest  of   territories.      These    disciples    and   pro- 


moters of  science  do  not  only  devote  all  their 
time,  all  their  energy,  their  genius  to  difficult  re- 
search work,  but  their  enthusiasm  in  science  and 
in  the  progress  of  new  methods  in  preventing  and 
healing  diseases  leads  them  to  pay  with  their  lives 
for  their  beautiful  discoveries.  The  martyrdom 
and  heroism  of  Dr.  James  Carroll,  our  alumnus, 
who  offered  himself  to  be  infected  with  the  deadly 
agent  of  yellow  fever,  and  who  died  from  the  re- 
mote effects  of  this  dreadful  disease  a  few  years 
after  voluntary  submission  to  infection,  is  an 
unique  accomplishment  in  the  annals  of  the  his- 
tory of  medicine.  If  we  consider  that  the  other 
two  members  of  the  Yellow  Fever  Commission, 
Major  Walter  Reed,  U.  S.  A. ;  Dr.  Jesse  W.  La- 
zear,  also  died  as  the  victims  of  these  dangerous 
investigations,  and  that  owing  to  their  discoveries 
the  proper  ways  of  prophylaxis  of  yellow  fever 
have  been  found,  we  must  admire  such  heroism. 
Such  examples  kindle  our  enthusiasm  in  scientific 
work,  and  following  their  steps  we  should  be  able 
to  contribute  to  humanity  by  our  own  work.  It 
is  no  doubt  a  great  privilege  for  the  University 
of  Maryland  to  claim  Dr.  James  Carroll,  the  im- 
mortal martyr  of  science,  as  one  of  her  alumni. 
Dr.  James  Carroll's  teachers  of  the  University  of 
Maryland  had  their  share  in  kindling  in  their 
pupil  this  admirable  devotion,  enthusiasm  and 
love  for  science.  The  history  of  the  University 
of  Maryland,  the  accomplishments  of  our  Alma 
Mater,  in  relatively  short  time,  is  a  splendid  proof 
of  the  high  ideals  of  this  institution.  The  great 
distinction  the  university  enjoys  among  other 
American  and  foreign  universities  is  the  result  of 
the  work  accomplished  by  its  famous  teachers  and 
alumni.  As  different  members  of  the  same  body, 
gifted  with  different  talents,  by  faithful,  untiring- 
perseverance  in  their  work,  by  their  personality, 
their  genius,  by  a  noble  demonstration  of  the 
ideals  of  life,  they  all  have  contributed  to  their 
best  ability  to  the  glory  of  the  university,  and  it 
is  such  a  difficult  task  to  render  full  justice  to  all 
the  prominent  medical  men  who,  by  their  contci- 
butions,  have  added  to  the  fame  of  the  university, 
and  through  them  have  won  the  recognition  of 
other  institutions  here  and  abroad. 

A  review  of  the  accomplishments  of  the  Uni- 
versity of  Maryland  in  the  past  fills  us  with  ad- 
miration of  the  work  done  by  teachers  connected 
with  this  school.  The  names  of  Dr.  George 
Brown,  Dr.  Nathaniel  Potter,  Dr.  Elisha  Bartlett, 
Dr.    William    Power.    Dr.    Samuel    Chew,    Prof. 


[88 


THE    HOSPITAL    BULLETIN 


Richard  McSherry,  Prof.  Samuel  S.  Chew,  Prof. 
C.  W.  Mitchell  recall  to  the  memory  of  the  audi- 
tors the  qualities  of  these  excellent  men,  to  whom 
we  feel  greatly  indebted.  The  scientific  work 
originated  in  the  laboratories  and  clinics  of  thev 
university  proves  that  the  men  in  charge  of  the 
medical  instruction  are  working  hard  for  the 
spread  of  science  and  experience.  They  have 
acquired  not  only  distinction  in  this  country,  also 
the}  are  well  known  among  foreign  scientific 
writers  and  investigators. 

Among  the  number  of  clinical  and  scientific  re- 
sults, only  a  few  may  be  mentioned  which  have 
greatly  contributed  to  the  renown  of  our  Alma 
Mater.  Owing  to  the  untiring  work  of  all  the 
members  of  the  surgical  department  its  fame  in 
successful  operations  has  spread  almost  over  the 
entire  country.  Valuable  scientific  information 
can  be  ascribed  to  different  papers  written  by  the 
members  of  our  faculty.  So  our  knowledge  has 
greatly  improved  with  regard  to  the  surgery  of 
infants,  of  the  thyroid  gland,  the  pathology  of  the 
hyoid  bone,  the  surgery  of  the  gall-bladder,  tuber- 
culosis of  the  kidneys,  tubercular  peritonitis, 
Meckel's  diverticulum,  etc.  The  four  large  vol- 
umes on  the  diseases  of  the  stomach  form  the 
first  complete  work  on  diseases  of  the  stomach 
published  in  the  English  language,  and  are  highly 
accredited  by  the  most  renowned  clinical  teachers 
as  a  standard  work  for  the  whole  medical  world. 
Not  less  renowned  are  the  two  volumes  of  diseases 
of  the  intestines  and  the  manual  of  Physiology  by 
the  same  writer;  they  all  furnish  a  splendid  proof 
of  the  competency  of  the  teachers  at  this  univer- 
sity. 

The  medical  profession  is  also  indebted  to 
teachers  of  the  University  of  Maryland  for  va- 
rious scientific  discoveries.  The  N-ray,  until  re- 
cently employed  only  in  the  demonstration  of  dis- 
eases of  the  bones,  was  first  used  in  the  recogni- 
tion of  diseases  of  the  digestive  tract  by  teachers 
in  the  University  of  Maryland.  The  Heterochylia, 
later  confirmed  by  Ewald  and  Boas  in  Berlin  and 
now  an  established  fact  in  medical  science,  was 
discovered  in  the  laboratory  of  the  University  of 
.Maryland. 

Also  the  intubation  of  the  duodenum,  published 
in  1897,  is  due  to  the  same  skillful  and  untiring 
investigator  of  our  school.  The  causal  connec- 
tion existing  between  the  salivary  glands  and  the 
stomach  secretion,  showing  that  the  extirpation 
of  the  first  mentioned  organs  results  in  a  loss  of 


secretion  of  the  gastric  glands,  is  another  result  of 
the  scientific  work  carried  out  in  the  University's 
laboratories.  These  results,  though  attacked  by 
investigators  who  were  not  familiar  with  the  tech- 
niCj  were  confirmed  in  Bickel's  laboratory  in  Ber- 
lin. Recent  discoveries  in  the  physiology  of  the 
heart  demonstrating  that  no  chemical  substance 
is  produced  in  the  myocardium,  that  was  arrested 
by  stimulation  of  the  vagus,  so  that  the  inhibition 
of  the  heart  calls  forth  another  explanation.  To 
accomplish  this  latter  discovery  the  faculty  of 
medicine  allowed  several  wagon-loads  of  valuable 
instruments  of  precision  kymographs,  etc.,  to  be 
transported  to  the  laboratory  of  the  United  States 
Fish  Commission  at  Woods  Hole,  Mass.,  where 
the  scientific  investigators,  Professor  Hemmeter 
and  Dr.  Albert  H.  Carroll,  were  working.  This 
liberality  on  the  part  of  the  Medical  Faculty  in 
encouraging  scientific  research  work  deserves 
especial  praise.  Scientific  investigation  in  met- 
abolism carried  out  in  the  laboratory  of  our  hos- 
pital demonstrates  the  capital  importance  of  a 
careful  study  of  quantitative  dietetics.  The  care- 
ful analysis  of  the  blood  serum,  the  defective  or 
insufficient  elimination  of  nocive  substances 
through  the  kidneys  represent  an  enormous 
amount  of  work,  which  by  its  practical  applica- 
tion in  the  change  of  diet  secured  the  suffering 
patients  remarkable  improvement  or  recovery 
from  their  ailments,  which  until  then  had  baffled 
the  skill  of  other  physicians.  Careful  study  of 
gastro-intestinal  cases  by  recent  means  of  inves- 
tigation allow  an  accurate  localization  and  diag- 
nosis of  the  pathological  process,  which  condi- 
tions stood  the  proof  of  the  autopsy  in  vivo,  by 
the  surgical  members  of  our  faculty  are  certainly 
accomplishments  which  corroborate  the  impres- 
sion that  the  members  of  the  University  of  Mary- 
land stand  in  the  foremost  rank  of  American 
medical  authors.  The  "History  of  Medicine"  has 
received  valuable  contributions  from  one  of  the 
members  of  our  faculty.  Not  only  the  remote 
Augustean  ideas  on  medicine  and  the  Greek  era 
have  become  more  accessible  to  our  understand- 
ing, but  also  the  life  and  accomplishments  of 
famous  members  of  the  medical  profession — such 
men  as  Charles  Frederick  Wiesenthal,  Henry 
Keerl.  ( iustavus  Brown — all  the  facts  in  regard 
to  the  lives  of  past  and  present  members  of  our 
University  have  been  carefully  colrected  in  the 
"History  of  the  University  of  Maryland,"  so  that 


THE    HOSPITAL    BULLETIN 


[89 


future  generations  will  derive  therefrom  valuable 
historical  information. 

These  allusions  will  demonstrate  that  the  Uni- 
versity of  .Maryland  stands  in  the  foremost  rank 
of  scientific  work  and  any  oiie  associated  with 
the  interests  of  this  scientific  body  must  experi- 
ence a  satisfaction  and  pleasure  in  joining  these 
ranks  of  progressive  workers  and  wish  to  help 
as  much  as  possible  in  the  realization  of  plans 
destined  to  increase  the  fame  of  our  Alma  Mater. 
Elected  to  the  chair  of  practice  of  medicine.  I 
wish  to  thank  the  Board  of  Regents  and  the  mem- 
bers of  the  Faculty  of  Physic  of  the  University 
if  Maryland  for  this  high  distinction.  In  ac- 
cepting such  a  position,  I  feel  the  great  responsi- 
bility of  my  work  and  am  impressed  with  the 
accomplishments  of  my  predecessors.  It  is  there- 
fore my  sincere  wish  to  maintain  the  high  stand- 
ard of  medical  teaching  at  the  LTniversity  of 
Maryland.  I  hope  that  my  previous  medical 
training  with  prominent  medical  professors  of 
this  and  of  the  old  country,  their  ideals  of  pro- 
gressive teaching  will  help  me  to  justify  the  con- 
fidence of  the  Faculty  of  Physic.  I  hope  that 
mutual  understanding  with  the  members  of  the 
faculty  will  favor  a  successful  work  for  the  best 
of  our  institution,  so  contributing  steadily  to  a 
still  greater  future  for  our  Alma  Mater. 

Medical  instruction  nowadays  has  become  such 
a  complex  question  that  the  task  of  best  benefit- 
ting the  student  appears  very  difficult.  Influenced 
by  many  different  factors,  by  local  conditions, 
the  results  vary  accordingly.  First  of  all,  the 
aims  in  teaching  the  students  the  essentials  for 
their  future  profession  are  to  be  considered ;  next. 
the  resources  of  the  institution,  and  finally,  the 
standard  of  the  students  ;  their  psychic  and  ethical 
qualities  forming  a  great  factor  in  successful 
teaching. 

In  regard  to  the  splendid  results  in  surgery, 
the  question  arises  whether  more  weight  should 
be  laid  on  a  careful  instruction  in  this  sister 
branch  of  internal  medicine.  Xo  doubt  the  con- 
quests of  the  knife  in  the  hands  of  a  skillful  sur- 
geon and  the  wonderful  results  in  the  warfare 
against  disease  and  death  inspire  admiration: 
whereas,  in  internal  medicine  the  results  of  treat- 
ment appear  only  slowly  and  after  much  pains- 
taking labor.  The  student  may  feel  inclined  to 
devote  himself  more  to  surgery  than  to  internal 
medicine.  At  the  conclusion  of  their  studies  a 
greater  number  of  them  tend  their  efforts  to  be- 


come famous  surgeons  and  only  a  small  percent- 
age of  promising  pupils  remain  faithful  adherents 
to  internal  medicine.  Since,  with  the  security 
of  careful  asepsis  the  autopsy  in  vivo  very  often 
discloses  without  much  trouble  the  real  cause  of 
disease,  is  it  still  necessary  for  the  student  to 
undergo  thorough  training  in  the  methods  of  phy- 
sical diagnosis?  Js  it  justifiable  to  subject  the 
patient  to  laborious,  time-robbing  methods  of  in- 
vestigation? Is  it  necessary  to  resort  to  the  use 
of  expensive  apparatus  for  the  sake  of  a  more 
definite  diagnosis,  where  the  knife  and  the  ex- 
perienced eye  can  easily  control  the  morbid  pro- 
cess in  regard  to  its  extent  and  its  localization? 
In  my  opinion,  the  student's  training  in  internal 
medicine  is  of  primary  importance,  since  we  have 
not  yet  reached  the  time  where  the  public  itself 
willingly  and  freely  submits  to  the  more  ex- 
tensive benefit  of  the  surgeon's  knife.  We  all 
agree  that  a  specialty  considered  only  for  itself, 
severed  from  its  relationship  to  other  disciplines, 
separated  from  the  broad  foundation  of  general 
medicine,  is  likely  to  lead  to  errors.  More  and 
more  we  have  to  demand  that  the  specialist  un- 
dergoes a  through  training  in  the  principal 
branches  of  general  medicine,  as  a  reliable  basis 
upon  which  to  build  his  specialty.  For  the  good 
surgeon,  it  is  of  the  greatest  importance  that  his 
connection  with  the  principles  of  internal  medi- 
cine are  never  severed.  Notwithstanding  the 
excellent  preparatory  instruction  given  to  the  stu- 
dent, as  soon  as  he  enters  upon  the  practical  clini- 
cal studies  it  seems  that  he  has  first  to  be  taught  to 
use  his  senses.  His  power  for  close  observation 
of  the  patient  has  to  be  developed,  as  the  outward 
observation  of  the  patient  in  many  instances  can 
furnish  important  information  in  the  case.  The 
ear  requires  the  subtle  training  of  the  musician 
to  differentiate  the  quality,  the  tonality  of  the 
sounds  transmitted  to  the  surface  of  the  body. 
The  delicate  touch  of  the  fingers  has  to  be  trained 
to  differentiate  the  outlines,  the  resistancv.  the 
qualities  of  vibration  of  the  underlying  organs. 
The  acuity  of  smell  has  to  be  educated  in  order 
that  pathological  changes  imparted  to  the  air 
may  not  be  overlooked.  These  requirements  are 
important  factors  in  medical  diagnosis  and  they 
are  obtained  only  by  an  assiduous,  thorough 
training  in  the  methods  of  physical  diagnosis. 
Next  to  these  simple  means  of  diagnosis,  human 
genius  has  furnished  us  with  much  expensive  ap- 
paratus as  valuable  helps  to  a  more  accurate  un- 


1 90 


THE    HOSPITAL    BULLETIN 


derstanding  of  the  pathological  processes.  The 
young  student  may  think  his  diagnosis  incom- 
plete without  resorting  to  these  elaborate  means 
of  investigation.  In  professional  practice,  how- 
ever, the  public  unfortunately  not  always  con- 
sents to  such  tedious  methods  of  clinical  diag- 
nosis. Often  the  patients  lack  understanding  of 
the  advantages  of  such  methods;  often  their 
financial  resources  are  restricted  and  forbid  such 
expense.  In  some  instances  we  remark  the  great 
difference  in  results  between  surgery  and  internal 
medicine. 

Modern  surgery,  as  an  exact  science,  has  ad- 
vanced by  leaps  and  bounds  owing  to  the  im- 
mense opportunities  of  proving  in  every  case  the 
correctness  or  incorrectness  of  diagnosis  by  the 
autopsy  in  vivo  in  internal  medicine.  In  a  lew 
diseases  i mly — typhoid  fever,  diphtheria,  tuber- 
culosis, relapsing  fever,  malaria — the  control  of 
diagnosis  is  obtained  by  the  laboratory  methods; 
for  instance,  by  examination  of  the  blood.  And 
still  so  many  changes  and  complications  within 
the  internal  organs  escape  our  attention  because 
of  the  impossibility  of  post-mortem  examination. 
It  must  be  our  aim  to  destroy  the  opinion  that 
medical  diagnosis  in  this  country  often  is  re- 
garded as  a  matter  of  clever  guessing  without 
the  necessary  demonstration  whether  one  is  right 
or  wrong.  The  value  of  post-mortem  examina- 
tions, where  every  mistake  made  in  diagnosis  is 
revealed,  can  never  be  overestimated.  There  is 
some  truth  in  the  assertion  that  students  will 
learn  only  by  the  mistakes  of  their  professors, 
and  later  by  their  own  in  the  position  of  hospital 
physicians.  Unless  they  are  taught  by  their  own 
mistakes,  they  will  never  become  good  diagnosti- 
cians. Unless  they  have  acquired  this  quality  of 
takin>v  advantage  of  exceptional  opportunities  dur- 
ing their  years  of  study  in  the  hospitals  their  pa- 
tients will  lie  inadequately  cared  for.  The  percent- 
age of  post-mortems  among  patients  who  die  in 
our  hospitals  is  absurdly  small  as  compared  with 
that  in  other  civilized  countries.  Few  hospitals 
are  able  to  hold  post-mortem  examinations  on 
in  per  cent,  to  25  per  cent,  or  even  less  of  their 
dead.  In  foreign  hospitals,  well  over  75  per  cent, 
is  the  rule;  in  Vienna  practically  100  per  cent. 
Even  in  the  old  Montreal  General  Hospital  of 
the  splendid  Royal  Victoria  Hospital,  the  hos- 
pital reserves  the  right  to  perform  an  autopsy 
upon  every  patient  dying  within  its  walls.  Noth- 
ing   could    more    advance    medical    science    and 


nothing  could  more  increase  the  efficiency  of 
every-day  practice  than  the  education  of  the 
vast  mass  of  the  population,  so  that  they  may- 
appreciate  the  fundamental  necessity  of  autopsies 
if  they  are  to  have  physicians  of  any  value  to 
them  when  their  time  comes  to  be  ill.  It  should 
lie  the  aim  of  medical  education  that  the  well 
trained  physician  wdierever  he  is  called,  even  to 
the  remotest  corners  far  distant  from  the  centers 
of  civilization,  should  be  trained  so  that  his 
close  observation,  his  well-trained  eyes,  ears  and 
fingers  render  him  valuable  service.  These  qual- 
ities direct  him  to  the  right  diagnosis,  even  under 
unfavorable  extrinsic  circumstances.  Supposing 
that  later  on  a  surgeon  and  pathologist  are  called 
to  control  the  physician's  findings,  is  it  not  grati- 
fying if  his  diagnosis  is  confirmed  by  these  pro- 
fessional friends?  Does  it  not  mean  a  great 
blessing  to  the  patient  if  his  case,  in  the  eyes  of 
his  physician,  becomes  transparent,  when  close 
observation,  accurate  examination,  personal  ex- 
perience and  thorough  knowledge  of  pathology 
and  symptomatology  contribute  not  only  to  diag- 
nosis, but  prognosticate  the  chances  for  recovery? 
At  all  times  the  diagnostic  skill  of  clinical  teach- 
ers has  attracted  hundreds  of  students  and  post- 
graduates, and  their  lessons  were  followed  with 
eager  interest.  It  cannot  he  denied  that  these 
masters,  too,  are  handicapped  by  external  condi- 
tions, that  in  some  instances  they  were  mistaken; 
but  this  meant  only  a  stimulant  to  them  in  aim- 
ing at  higher  perfection  of  their  methods. 

If  we  admit  the  primary  importance  of  clinical 
training  of  the  medical  student,  the  practical 
solution  of  this  problem  will  never  be  absolutely 
objective.  Every  teacher,  enthusiastic  of  his  own 
methods,  imparts  to  his  teaching  his  personal 
character.  As  a  rule  medical  instruction  follows 
the  laws  of  evolution.  It  means  a  gradual  rise 
from  simple  tasks  to  more  complex  problems, 
mail  the  pupil  reaches  a  position  from  where  we 
see  him  safely  and  independently  advance  on  the 
way  to  perfection.  The  course  of  evolution 
from  the  medical  student  to  the  accomplished 
medical  man  reminds  me  of  the  construction  of 
a  skyscraper :  these  long-lasting  monuments  of 
human  skill  and  genius  in  modern  technic.  From 
the  solid  foundation,  amalgamated  with  mother 
earth,  we  see  the  big  steel  frame  point  toward 
the  sky,  gradually  the  gaping  spaces  are  filled 
out  and  finally  we  see  the  work  completed  as  a 
beautiful  monument,  able  to  face  all  elements;  all 


THE    HOSPITAL    BULLETIN 


191 


extrinsic  influences  of  its  surroundings.  The 
Foundations  of  the  students'  knowledge  arc  the 
natural  sciences,  anatomy  and  physiology,  upon 
which  all  the  subsequent  instruction  is  built.  If 
the  greatest  care  lias  not  been  taken  to  make  this 
basis  as  strong  as  possible,  if  there  are  unfilled 
gaps  left,  the  energ)  of  the.  studenl  is  generally 
ncit  strong  enough  to  reinforce  these  weak  points 
of  his  knowledge  by  personal  studies.  The  work 
of  previous  teachers  deserves  our  appreciation, 
and  training  in  the  principles  of  clinical  medicine 
forms  only  a  necessary  and  important  link  in  the 
chain  of  influences  to  which  the  student  must  be 
exposed.  Our  main  object  must  always  be  to 
give  the  student  practical  as  well  as  theoretical 
knowledge;  so  that  when  he  has  to  show  the  ex- 
tent of  his  knowledge  before  the  State  board  and 
bi  fore  the  public,  he  will  be  able  to  qualify  as  a 
most  useful  member  of  the  medical  profession. 

Theoretical  knowledge  has  to  precede  practical 
instruction:  therefore,  the  student  had  better 
master  didactic  medicine  in  his  third  year.  Be- 
sides his  training  in  physical  diagnosis,  he  must 
study  the  dispensary,  for  this  prepares  him  for 
a  greater  and.  more  successful  understanding  of 
the  medical  clinic.  At  the  dispensary,  under  the 
supervision  of  the  professor,  the  student  acquires 
his  experience  in  history  taking,  in  the  practice 
of  physical  diagnosis,  in  judging  the  cases  with 
regard  to  prognosis  and  treatment.  There,  in 
daily  contact  with  the  suffering  of  poorer  pa- 
tients, the  student  sees  that  medicine  means  a 
much  larger  field  of  activity  than  is  generally 
admitted.  Not  disease  itself  only,  but  diseased 
individuals  have  to  he  cared  for;  often  the  social 
surroundings  have  to  be  improved  before  any 
evident  success  is  to  be  hoped  for.  This  is  the 
opportunity  at  which  the  student  shows  the  qual- 
ities of  hi,  character  and  where  he  can  excel  in 
following  the  demands  of  charity.  At  first  the 
student  follows  the  medical  clinic  as  an  auditor, 
listening  to  the  clinical  exposition  of  the  cases 
presented  and  taking  advantage  of  the  answers 
of  the  senior  students,  who- are  called  to  examine 
and  debate  on  the  clinical  cases.  Unfortunately 
the  medical  classes  are  always  large,  and  there- 
fore the  difficulty  which  arises  is  how  to  find 
space  large  enough  to  teach  juniors  and  seniors 
together.  No  doubt  the  system  of  co-education 
of  juniors  and  seniors  offers  many  advantages. 
The  junior  student,  eager  to  progress  in  the  un- 
derstanding of  clinical   medicine,  has  an  oppor- 


tunity to  show  his  teacher  that  he  can  ably  ans- 
wer the  questions  calculated  for  the  senior.  For 
the  senior  this  co-education  is  a  powerful  stimu- 
lant to  a  more  thorough  knowledge.  He  generally 
dislikes  to  expose  his  ignorance  to  the  criticism 
of  his  junior  fellow-students.  So  first-class  work 
bei  omes  second  nature  to  the  senior  student.  He 
experiences  the  advantages  to  himself,  and  the 
good  habit  is  formed.  The  principal  aim  in  the 
instruction  of  the  senior  student  is  his  practical 
clinical  training.  In  the  clinic,  at  the  bedside  of 
the  patient,  the  framework  of  his  knowledge  is 
filled  out  by  important  details  in  the  symptoma- 
tology, pathology,  diagnosis  and  treatment  of 
each  case.  He  is  entrusted  to  work  out  his 
clinical  cases  carefully,  to  make  most  of  the  ex- 
aminations himself,  to  discuss  thoroughly  before 
the  whole  audience  his  findings.  Allowed  to  fol- 
low his  patient  more  closely  in  the  ward,  the  stu- 
dent is  fortunate  to  gather  important  informa- 
tion on  the  course  of  the  case,  reporting  upon  it 
to  his  teacher.  A  short  review  of  the  case  may 
be  helpful  and  leave  a  deeper,  longer-lasting  im- 
pression in  his  memory.  Conferences  on  clinicnl 
fatal  cases  conjointly  with  the  professor  of  pati. 
ology  may  be  another  help  for  clinical  instruc- 
tion. So  step  by  step  the  clinical  teacher  will 
see  his  pupil  grow  into  a  medical  personality  to 
whom  he  can  entrust  any  case,  convinced  that  the 
pupil  will  do  his  best  work.  This  is  the  aim  of 
clinical  teaching  and  the  sincere  wish  of  the 
teacher  is  to  conduct  all  his  pupils  to  careful 
training,  to  reliable  practical  experience  and  per- 
fect knowledge. 

With  the  teaching  of  the  students,  the  task  of 
the  clinical  professor  is  far  from  being  com- 
pleted. His  influence  has  to  extend  to  his  as- 
sistants, who  conscientiously  do  the  work  in  the 
different  wards.  In  making  rounds  in  the  wards 
there  is  so  much  opportunity  to  control  and  ad- 
vance  the  work  of  the  young  colleague;  to  help 
him  to  reach  the  goal  of  an  accomplished  phy- 
sician and  teacher.  His  interest  in  medical  prob- 
lems, in  useful  ingenious  research  work,  can  be 
aroused  and  trained.  The  medical  clinic,  an  in- 
stitution destined  to  promote  medical  science  and 
control  by  close  observation  on  a  greater  scale 
the  assertions  and  suggestions  of  outside  investi- 
gators, must  aim  to  give  its  alumni  and  the  mem- 
bers of  the  medical  profession  reliable  informa- 
tion about  the  value  of  new  methods  of  diagnosis 
and   treatment.      Rut   also   to   outside   physicians 


102 


THE    HOSPITAL    BULLETIN 


anil  to  alumni  the  medical  clinic  has  to  be  the 
seat  of  learning  wherefrom  valuable  information 
can  always  be  obtained ;  it  has  to  favor  genuine 
research  work,  accomplished  by  its  own  means. 
The  practitioner,  conscious  of  some  lack  of  ex- 
perience in  certain  branches  of  clinical  medicine, 
should  always  find  there  an  opportunity  for  post- 
graduate work.  Cases  doubtful  in  regard  to  diag- 
nosis should  be  referred  to  the  medical  clinic  for 
further  careful  observation  and  examination.  A 
similar  suggestion  might  be  made  for  insurance 
and  medico  legal  cases,  where  greater  opportuni- 
ties are  available  for  a  better  interpretation  of 
the  pathognostic  features.  Without  doubt,  there 
are  many  factors  that  make  the  task  of  the  pro- 
fessor for  the  practice  of  medicine  very  attrac- 
tive, and  which  can  only  be  briefly  mentioned. 
The  resources  of  our  institutions  are  well  known 
and  much  appreciated.  In  this  work,  gradually 
expanding,  it  is  to  be  hoped  that  more  influential 
and  benevolent  men  may  become  interested  in 
the  present  and  future  tasks  of  the  University 
of  Maryland,  and  from  their  abundant  financial 
means  will  contribute  to  the  success  of  our  ideals 
in  medical  teaching.  The  standard  of  students, 
the  psychical  qualities  of  the  medical  man,  is  a 
vast  and  important  topic  which  may  be  better 
exposed  before  the  students  themselves. 

Finally,  I  would  mention  one  point  of  interest 
to  the  medical  profession.  It  is  the  conviction  of 
the  leading  classes  that  medical  art  in  this  coun- 
try is  still  in  its  infancy  and  that  with  all  our 
distinguished  medical  men  difficult  medical  cases 
cannot  be  treated  properly  at  home.  As  a  proof 
of  the  proverb.  "A  prophet  is  not  without  honor, 
except  in  his  own  country."  Every  vear  we  no- 
tice quite  an  exodus  of  wealthy  patients  making 
their  way  to  the  clinics  of  Europe.  It  is  an  open 
question  whether  they  will  receive  better  atten- 
tion over  there  than  they  would  have  at  home, 
but  this  means  a  serious  danger  to  the  fame  of 
the  American  profession.  At  this  instance  an 
experience  of  a  Baltimorean  may  be  quoted,  who 
visited  Professor  Strumpell  at  Breslau.  The 
professor  asked  the  patient  where  he  was  from. 
The  answer  from  the  patient,  ''From  Baltimore, 
sir."  Professor  Strumpell  said :  "Then  go  back 
and  put  yourself  under  the  care  of  one  of  our 
distinguished  members  of  the  faculty  of  the  Uni- 
versity of  Maryland."  So  it  will  be  the  duty  of 
the  universities  to  join  the  ranks  of  benefactors 
to  humanity  to  show  the  public  that  the  medical 


profession  gets  an  instruction  in  all  branches  of 
medicine,  comprising  physical  treatment,  balneo- 
climato-dietotherapy ;  that  reliable  institutions 
are  directed  by  well  experienced  doctors  just  as 
in  the  old  country,  and  that  the  results  compare 
favorably  with  those  reported  from  abroad.  No 
doubt  this  aim  will  be  reached  in  time  and  fos- 
tered by  the  financial  help  of  the  public,  this  on- 
ward movement  to  perfection  in  all  branches  of 
medical  experience  and  teaching  will  add  another 
laurel  to  the  reputation  of  the  American  nation. 
In  conclusion  of  my  discussion  of  the  aims  of 
clinical  teaching  of  medicine,  I  only  hope  that  the 
work  at  the  medical  clinic  has  but  begun  viribus 
unitis  of  the  past  ami  the  present.  In  such  a  task 
the  interest  of  the  University  of  Maryland  and 
its  medical  faculty  is  not  only  at  stake,  but  also 
the  interests  of  the  entire  medical  profession. 
In  the  proper  education  of  the  medical  students, 
we  have  to  contribute  our  share  to  humanity  as 
well  as  to  the  benefit  of  our  country,  whom  we 
try  to  serve  with  our  best. 


A  PROBABLE  CASE  OF  INFANTILE 

PARALYSIS    IN   ANCIENT 

EGYPT. 


By  Etnar  Hansen. 


Dr.  Hamburger  of  Copenhagen,  wdio,  besides 
his  duties  as  a  physician,  devotes  part  of  his  time 
to  the  study  of  the  art  of  ancient  Egypt,  speaks 
of  human  abnormalities  often  met  with ;  some 
easily  recognized  by  everyone,  but  also  others 
misunderstood  by  the  Egyptologist  on  account  >u 
lack  of  anatomical  and  pathological  knowledge. 
Many  of  these  last  named  are  often  explained  as 
being  a  mistake  of  the  artist. 

The  following  is  from  an  article  in  Ugeskrift 
for  Laeger  by  Dr.  Hamburger: 

"In  the  Egyptian  division  of  "Ny  Carlsberg 
Glvpothek,"  Copenhagen,  you  will  find  a  'Stc!.'' 
(monumental  stone  plate)  dating  from  the  eigh- 
teenth dynasty,  about  2500  years  before  Christ. 

"<  In  this  plate  can  be  seen  three  human  figures 
surrounded  by  hieroglyphics.  The  principal  fig- 
ure is  a  man  with  a  bowl  in  his  left  hand ;  his 
head  is  shaven,  which  indicates  he  is  a  pries1. 
Around  his  hips  is  a  cloth,  reaching  to  his  knees, 
but  made  of  such  transparent  material  that  both 
his  thighs  are  easily  seen.  Behind  him  you  see  a 
woman,  his  wife.     In  her  left  hand  she  is  carrv- 


THE    HOSPITAL    BULLETIN 


193 


Engraving  from  a  Library  in  Copenhagen,  which  illustrates 
the  possibility  that  the  ancient  Egyptians  suffered  with 
infantile  paralysis. 


ing  a  sacrificial  bowl ;  the  right  hand  is  leading  a 
sacrificial  lamb.  In  the  farthest  right  corner  you 
see  the  figure  of  a  little  child. 

"The  hieroglyphics  tells  us  the  man's  name  is 
'Ruiiia,'  and  that  he  is  the  caretaker  of  the  temple. 

"The  goddess  to  whom  he  is  making  an  offer- 
ing is  the  Syrian  'Astarte,'  who,  according  to 
Herodotus,  had  a  temple  in  Memphis,  in  lower 
Egypt.  The  names  of  the  man  and  woman  are 
Syrian  ;  the  boy's  name  Egyptian. 

"When  you  look  closely  you  will  see  that  the 
figures  are  cut  very  distinctly  by  the  artist,  with 
precision  and  delicacy,  but  also  that  there  is  some- 
thing wrong  with  the  man's  leg. 

"Of  course,  this  abnormality  has  been  noticed, 
and  in  the  catalogue  you  read :  The  drawing  is 
not  especially  good.  The  man's  one  foot  and  leg 
is  absolutely  deformed;  the  'Stele'  is  possibly 
from  a  later  period,  when  the  Egyptian  art  ivas 
decadent.  If  the  aforequoted  Egyptologist  had 
been  a  physician,  he  would  surely  not  have  made 
that  statement. 

"In  this  case  there  is  undoubtedly  no  misdraw- 
ing.      The   artist   has   produced   a   man   with    a 


'withered'  leg.  The  foot  is  in  the  typical  Equinus- 
position.  The  slight  flexion  of  the  hip  and  knee 
joints  is  not  enough  to  raise  the  heel  so  high  from 
the  ground.  There  is  a  shortening  of  femur, 
tibia  and  fibula.  The  whole  leg  is  diminished  in 
size.  Another  thing  that  speaks  for  the  correct- 
ness of  the  drawing  is  the  way  Ruma  is  carrying 
his  staff. 

"It  is  originally  the  kind  of  cane  Egyptians  of 
quality  used  to  carry,  but  in  old  pictures  we  al- 
ways see  them  carrying  it  in  front  of  them,  and 
parallel  with  the  body. 

"Ruma  is  carrying  his  cane  in  an  unusual  way, 
crosswise  from  the  shoulder,  in  the  bend  of  the 
elbow  and  alongside  the  withered  leg,  apparently 
as  a  support. 

"If  the  artist  has  drawn  the  man  as  he  was  in 
life,  it  seems  natural  to  think  of  either  infantile 
paralysis  or  coxitis  as  being  the  cause  of  the  de- 
formity, and  of  these  two  infantile  paralysis  seems 
the  most  probable. 

"The  stone  tells  us  a  little  tale  of  3500  years 
ago.  The  Syrian  Ruma  who  has  had  an  attack 
of  infantile  paralysis  does  not  die  of  it ;  he  grows 
up  with  his  withered  leg  and  his  pes  equinus ;  he 
marries  a  Syrian  woman,  and  they  both  emigate 
to  Egypt,  where  he  becomes  a  priest  in  Astartes' 
temple,  in  Memphis.  A  son  is  born  in  Egypt ;  the 
hieroglyphics  give  us  his  Egyptian  name. 

"Ruma  dies,  and  the  artist  draws  his  picture 
on  a  tombstone,  carefully  bringing  in  the  withered 
leg  and  the  pes  equinus. 

"The  drawing  does  not  tell  whether  poor  Ruma 
ever  was  treated  by  an  orthopedic  specialist,  but 
if  he  was,  the  treatment  was  not  very  successful." 

221  W.  57th  Street,  New  York. 


Among  the  University  alumni  practicing  in 
Arkansas  are : 

Camden — George  W.  Hudson,  class  of  1875. 

Dardanelle — A.  H.  McKenzie,  class  of  1872. 

Fort  Smith — Errett  Campbell  Myers,  class  of 
1870.  Arkansas  Valley  Transit  Building. 

Hot  Springs — Jos.  Smith  Horner,  class  of  1883, 
AZ°lA  Central  avenue;  Wm.  Turnor  Wooten, 
class  of  1899,  Dugan-Steuart  Building. 

Pine  Bluff — Thomas  Littleton  Savin,  class  of 
1896,  Barraque  and  Pine  streets. 

Texarkana — Leonce  J.  Kosminsky,  class  of 
.1906. 


194 


THE    HOSPITAL    BULLETIN 


THE   HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

PUBLISHED  BY 

THE  HOSPITAL  BULLETIN   COMPANY 
608  Professional  Building 

Baltijioke,  I'd. 


Subscription  price,     .     .     .     $1.00  per  annum  in  advance 

.  Reprints   furnished   at   cost.     Advertising   rates 

submitted  upon  request 


Nathan  Winslow,  M.D.,  Editor 


Baltimore,  December  15,  1912. 


[LLNESS  OF  PROF.  JOHN  C.  HEMMETER. 


Professor  Hemmeter  has  been  in  poor  health 
for  some  time,  but  has  been  able  ti  1  attend  to  his 
duties  at  the  University  and  to  his  private  prac- 
tice. He  arranged  and  was  present  at  the 
Academic  Day  exercises,  and  at  the  luncheon  at 
the  Emerson  Hotel  on  the  same  day.  Two  days 
later  he  was  taken  ill  and  has  been  under  the  care 
of  Prof.  Zueblin  since  that  time.  It  is  with  great 
pleasure  that  we  announce  an  improvement  in  his 
condition,  though  it  may  be  some  time  before  he 
will  be  able  to  resume  his  work. 

Professor  Hemmeter  is  a  great  ornament  to 
the  University,  and  his  enforced  absence  is  a 
great  loss  to  us.  May  the  good  God  restore  him 
to  health  and  usefulness! 


CLINICS  AT  THE  UNIVERSITY 
HOSPITAL. 


The  month  of  November  was  especially  sig- 
nalized by  the  visits  of  many  distinguished  men 
to  the  University  Hospital.  Early  in  the  month 
1  >r.  Arthur  Dean  Bevan,  professor  of  surgery  in 
Rush  Medical  College,  met  the  representatives  of 
the  three  Baltimore  medical  schools  at  a  luncheon 
given  by  the  hospital,  and  urged  the  necessity  of 
a  combination  of  these  schools.  We  believe  his 
efforts  will  bear  fruit  in  the  near  future.  Later 
the  Interurban  Orthopedic  Club  attended  a  clinic 
held  by  Drs.  Randolph  Winslow,  Irving  I.  Spear 
and  Conrpton  Riely.  The  next  day  Dr.  Fred  H. 
Albee  of  New  York  demonstrated  his  method  of 
grafting  a  piece  of  bone  from  the  tibia  into  the 
vertebral  column  in  Potts'  disease.    The  operation 


is  not  difficult,  and  the  results  are  said  to  be  re- 
markable. 

The  Xu  Sigma  Xu  Fraternity  held  its  annual 
convention  in  Baltimore  during  the  Thanksgiving- 
holidays  and  attended  a  clinic  at  the  hospital,  at 
which  Drs.  R.  Tunstall  Taylor,  Jose  L.  Hirsh 
and  Hiram  Woods  gave  instructive  discourses. 
We  were  also  favored  with  two  very  instructive 
clinics  for  our  senior  class  by  Dr.  Richard  C. 
Cabot  of  Harvard  Medical  School.  Dr.  Cabot  de- 
parted from  the  usual  way  of  conducting  clinics 
by  adopting  the  cjuiz  method.  The  students  were 
taken  by  surprise  when  he  called  them  by  name 
and  made  them  work  out  the  subject.  This  meth- 
od is  by  no  means  new  to  them,  however,  as  Pro- 
fessor Mitchell  has  long  taught  in  this  manner, 
and  the  other  clinical  teachers  to  a  large  extent  do 
the  same.  Professor  Cabot's  clinics  were  on  heart 
disease  and  neurasthenia,  ami  we  were  able  to 
supply  him  with  a  good  supply  of  illustrative 
cases. 


A  HANDSOME  GIFT. 


The  Academic  Day  exercises  on  November  12 
were  dignified  and  striking,  though  perhaps  a 
little  sombre,  as  two  of  the  addresses  were  me- 
morial tributes  to  our  late  Provost,  Bernard  Car- 
ter. LL.D..  and  to  John  Wirt  Randall,  LL.D., 
President  of  the  Board  of  Governors  and  Visitors 
of  St.  John's  College  and  a  Regent  of  the  Uni- 
versity. Prof.  Ernest  Zueblin  made  an  enthusi- 
astic and  inspiring  address  on  the  "Aims  of  Clini- 
cal Teaching."  The  most  important  feature  of  the 
1  iccasion,  however,  was  the  announcement  by  the 
acting  Provost,  Judge  Stockbridge,  of  an  addi- 
tional gift  by  Prof,  and  Mrs.  John  C.  Hemmeter 
of  S5300  towards  the  endowment  of  the  Hem- 
meter chair  of  physiology.  Their  gifts  now 
amount  to  about  $10,000.  The  amount  available 
for  the  department  of  pathology  now  approxi- 
mates $20,000,  and  is  slowly  increasing,  though 
not  in  proportion  to  the  effort  that  has  been  ex- 
pended in  the  endeavor.  Will  not  some  generous- 
ly disposed  people  aid  us  to  raise  the  $100,000  we 
need  so  sorely? 

CONTRIBUTION     BY    CLASSES. 

1848 $50  OO 

1  Si  14 20  OO 

1868 IO  OO 

1 87 1 35  00 

1872 81  84 


THE    HOSPITAL    BULLETIN 


195 


E873 • 44i  83 

1874 5  00 

1875 5  00 

1 N71  > 115  00 

1 877 10  00 

1880 5  00 

1  ss  1 252  00 

1 882 310  00 

1883 40  00 

1  ss  1 40  00 

1885 235  00 

1886 100  00 

1S88 50  00 

1889 100  00 

1890 175  00 

1 892 1 50  00 

[893 40  00 

1894 135  00 

'?95 155  00 

1896 52  00 

1897 80  00 

i.'mS 115  00 

[899 55  00 

1900 215  00 

1901 270  00 

1902 330  00 

[903 340  00 

1904 •  135  00 

1905 220  00 

[906 175  00 

1907 no  00 

s 20  00 

M  H  9 15  00 

1910 50  00 

191 1  Terra  Mariae 3  5° 

]'ii-'  Club  Latino  Americano 25  00 

Total  subscriptions  to  Dec.  1,  1912.  .$10,322  17 

NEW    SUBSCRIPTIONS    IX    NOVEMBER. 

I  [orace  M.  Simmons,  1881 $2  00 

I.  Royston  < ireen,  1899 5  00 

Daniel  A.  Watkins,  1903 25  00 

John  S.  Norman,  1900 10  00 

Ti  >tal  $42  00 


Mr.  Albert  O.  McFaddin  of  the  junior  med- 
ical cla^s,  who  has  been  for  several  months  con- 
lined  to  the  hospital  suffering  from  typhoid 
fever,  has  fully  recovered  and  is  now  attending 
his  class  lectures. 


ITEMS 

A  committee  of  one  member  from  each  depart- 
ment of  the  University  was  appointed  in  Sep- 
tember to  consider  the  selection  of  a  provost  to 
succeed  the  late  Bernard  Carter.  The  members 
of  the  committee  are  Philemon  H.  Tuck  of  the 
Department  of  Arts  and  Science,  Dr.  Thomas 
A.  Ashby  of  the  Department  of  Medicine,  Joseph 
C.  France  of  the  Department  of  Law,  Dr. 
Timothy  O.  Heatwole  of  the  Department  of 
Dentistry  and  Dr.  David  M.  R.  Culbreth  of  the 
Department  of  Pharmacy.  The  committee  will 
recommend  to  the  Board  of  Regents  at  its  meet- 
ing this  month  that  Dr.  Thomas  Fell,  for  26 
years  president  of  St.  John's  College,  be  named 
as  Mr.  Carter's  successor.  The  plan  as  proposed, 
according  to  current  rumor,  is  that  Dr.  Fell  will 
be  asked  to  open  an  office  at  the  University  and 
give  Saturdays  and  at  least  two  afternoons  a 
week  to  the  work  of  the  entire  institution.  An 
office  force  will  be  selected  to  assist  him.  The 
Sun,  in  speaking  of  Dr.  Fell,  says: 

"Dr  Fell  is  regarded  as  one  of  the  leading 
educators  of  this  part  of  the  country.  His  abil- 
ity as  an  administrator  has  been  tried  as  the 
president  of  St.  John's  College.  In  the  opinion 
of  all  who  have  watched  the  growth  of  that  in- 
stitution under  his  leadership  he  has  been  remark- 
ably successful. 

"When  he  assumed  charge  of  the  old  institu- 
tion, which  was  founded  in  1696  and  thus  ranks 
as  one  of  the  oldest  colleges  in  America,  a  great 
deal  of  its  prestige  had  been  lost,  and  there  was 
danger  that  it  would  suffer  the  same  fate  as  a 
number  of  other  small  colleges  had. 

"With  signal  ability  Dr.  Fell  set  to  work  to 
restore  St.  John's  to  its  former  position.  When 
he  took  charge  there  was  a  long-standing  mort- 
gage of  $30,000  hanging  over  the  school. 
Through  his  efforts  that  has  been  entirely  wiped 
out.  The  final  accomplishment  of  his  adminis- 
tration was  the  merging  of  St.  John's  with  the 
University  of  Maryland." 

Dr.  Fell  was  born  in  Liverpool,  England.  July 
15,  1851.  His  father  was  a  surgeon  in  the  Eng- 
lish Army,  and  was  killed  in  the  Crimean  War. 
Dr.  Fell  was  educated  at  the  Royal  Institution 
School  of  Liverpool  and  at  King's  College,  Lon- 
don. He  later  entered  the  University  of  London, 
and  then  studied  for  a  year  at  the  University  of 
Munich.     He  came  to  America  in   1882.  and  in 


196 


THE    HOSPITAL    BULLETIN 


1884  was  elected  professor  of  ancient  languages 
at  New  Windsor  College,  New  Windsor,  Md. 
In  1886  he  was  elected  to  the  presidency  of  St. 
John's  College,  being  the  12th  president  of  its 
now  123  years  of  existence.  St.  John's  College 
has  conferred  upon  him  the  honorary  degree  of 
doctor  of  philosophy,  and  the  University  of  the 
South  that  of  doctor  of  civil  law,  while  Hampton- 
Sidney  College  has  honored  him  with  the  degree 
of  doctor  of  laws.  His  standing  as  an  educator 
is  recognized  everywhere.  Dr.  Fell  is  a  member 
of  the  American  Philological  Association,  the 
National  Educational  Association,  the  Phi  Sigma 
Kappa  Fraternity,  the  University  Club  of  Balti- 
more and  the  Cliosophic  Society  of  Princeton 
University. 


Among  the  University  alumni  practicing  in 
Colorado  are: 

Boulder — Wni.  J.  Baird.  class  of  1881. 

Canon  City — Wm.  Booth,  class  of  1865. 

Denver — William  C.  Mitchell,  class  of  1889, 
California  Building;  Edmund  C.  Rivers,  class  of 
1879,  if>32  Welton  street;  William  A.  Sedwick, 
class  cf  1893,  Metropolitan  Building. 

Fort  Logan — J.  R.  Shook,  class  of  1899,  Major 
M.  C.,U.  S.  A.  ' 

Grand  Junction — Samuel  J.  King,  class  of  1903. 

Somerset — Morris  Ramsey  Bowie,  class  of 
1908. 


Dr.  Louis  McLane  Tiffany,  class  of  1868,  who 
was  operated  upon  recently  by  Drs.  Frank  Martin 
and  George  Walker  at  the  Union  Protestant  In- 
firmary, is  reported  to  be  considerablv  improved. 


Dr.  William  F.  Wegge,  class  of  1886,  of  Cas- 
well Block.  Milwaukee,  Wis.,  was  a  member  of 
the  commission  of  five  appointed  to  report  upon 
the  sanity  of  John  Schrank,  assailant  of  Col. 
Theodore  Roosevelt.  Copies  of  the  ruling  of  the 
commission  in  declaring  Schrank  a  paranoiac 
have  been  requested  by  large  libraries  through- 
out the  country,  and  will  be  supplied  to  them. 


Dr.  John  Turner.  Jr.,  class  of  1892,  has  just 
returned  from  a  trip  covering  several  thousand 
miles  by  way  of  Colon,  Panama,  San  Francisco, 
Salt  Lake  City,  Denver,  Omaha,  Chicago  and 
Pittsburgh.  Shortly  after  his  return  he  was  the 
victim   of   a    telephone    hoax,    some    anonymous 


person  telephoning  the  coroner  of  the  Northern 
District  that  Dr.  Turner  had  died.  Dr.  Turner 
is  in  the  best  of  health,  and  responded  in  person 
to  the  many  inquiries  concerning  his  supposed 
death. 


Dr.  Henry  Waters  Kennard,  class  of  1889,  has 
been  appointed  assistant  superintendent  of  the 
School  for  Feeble-Minded  at  Owings  Mills.  He 
will  shortly  resign  his  commission  in  the  State 
Militia  as  lieutenant  of  Company  A,  Medical 
Corps.  He  has  been  actively  engaged  in  the 
National  Guard  for  a  number  of  years,  par- 
ticipating in  the  recent  encampment  and  in  work 
at  the  armorv. 


Dr.  John  I.  Pennington,  class  of  1869,  is  se- 
riously ill  at  the  Mercy  Hospital,  suffering  from 
the  effects  of  a  fall  from  a  street  car.  Dr.  Pen- 
nington boarded  the  car  and,  finding  it  was  go- 
ing  south  instead  of  north,  leaped  off,  missed  his 
footing  and  fell  on  his  head.  The  accident  oc- 
curred near  St.  Paul  and  23d  streets.  Dr.  Pen- 
nington was  placed  aboard  the  car  and  hurried 
to  the  office  of  Dr.  A.  C.  Harrison,  31  E.  North 
avenue.  Dr.  Harrison  examined  him  and  took 
him  at  once  to  the  Mercy  Hospital,  where  he  is 
reported  to  be  improving. 


The  American  Surgical  Association  has  ap- 
pointed a  committee  consisting  of  Drs.  William 
L.  Estes,  South  Bethlehem,  Pa. ;  Thomas  W. 
Huntington,  San  Francisco.  Cal. :  John  B. 
Walker,  New  York  City;  Edward  Martin,  Phil- 
adelphia, and  John  B.  Roberts,  chairman.  313  S. 
17th  street,  Philadelphia,  to  report  on  the  oper- 
ative and  non-operative  treatment  of  closed  and 
open  fractures  of  the  long  bones  and  the  value  of 
radiography  in  the  study  of  these  injuries.  Sur- 
geons who  have  published  papers  relating  to  this 
subject  within  the  last  10  years  will  confer  a  favor 
by  sending  two  reprints  to  the  chairman  of  the 
committee.  If  no  reprints  are  available,  the 
titles  and  places  of  their  publication  are  desired. 
John  B.  Roberts, 

Chairman. 

313  S.   17th  Street,  Philadelphia.  Pa. 

We  are  aware  that  several  alumni  of  the  Uni- 
versity have  published  papers  on  the  open  method 
of  treatment,  and  we  hope  that  some  of  them 
will  respond  to  this  call. 


THE    HOSPITAL    BULLETIN 


[97 


Bishop  1  uther   Barton  Wilson,  a  member  of  walked  in  and  disputed  the  question  with  us— 

the  medical  class  of   1877  and  son  of  Dr.  Henry  said  he  was  perfectly  sure  he  hadn't  died  lately, 

M    Wilson    class  of  1850.  now  resident  head  of  and   then— Oh,   cruel!— he   told   the   tale.     And 

the  Methodist   Episcopal  Church  of  New  York,  though  the  world  says  medical  men  are  solemn, 

celebrated  Ins  56th  birthday  November  14.  I9"-  we  have  proof  that  they  can  laugh  right  heartily. 


\  meeting  of  the  [nterurban  Orthopedic  Club 
was  held  on  November  18  and  19,  in  Baltimore, 
with  headquarters  at  the  Belvedere  Hotel.  (  >n 
Monday  the  members  attended  a  clinic  in  the  am- 
phitheater of  John-  Hopkins  Hospital,  where 
from  c)  to  12.45  they  witnessed  and  heard  of  work- 
done  by  physicians  connected  with  that  institu- 
tion. Dr.  Henry  M.  Thomas,  class  of  1885,  pre- 
sented a  case  of  periodic  paralysis  with  muscular 
dystrophy.  The  club  was  then  entertained  at 
luncheon  at  the  home  of  Dr.  Howard  A.  Kelly, 
later  going  to  the  Children's  Hospital  School,  on 
Green  Spring  avenue.  Among  the  cases  pre- 
sented were  two  of  fracture-dislocation  of  spine, 
bv  Dr.  Howard  Elmer  Ashbury,  class  of  1903. 
The  club  then  attended  a  business  meeting  at  the 
Baltimore  Country  Club,  dining  there.  On  No- 
vember 19  the  first  clinic  was  held  at  the  Union 
Protestant  Infirmary,  and  at  1 1  A.  M.  the  visitors 
repaired  to  the  University  Hospital,  where  they 
observed  the  following  program: 

1 1. 00 — Dr.  Randolph  Winslow,  class  of  1873. — 
"Fracture  of  Neck,  of  Femur  and  of  Surgical 
Neck  of  Humerus.    Operative  Treatment." 

11.15 — ^r-  Compton  Riely,  class  of  1897. — 
"Remarks  on  Spinal  Abscess.  Exhibition  of 
Radiograms  and  Presentation  of  Cases.'' 

11.45 — lJr-  Irving  J-  Spear,  class  of  1900. — 
"Results  After  Section  of  Posterior  Spinal  Nerve 
Roots.     Exhibition  of  Cases." 

At  12.15  a  clinic  began  at  the  Mercy  Hospital. 
Dr.  A.  C.  Harrison,  class  of  1887,  demonstrated 
the  use  of  the  Downey  extension  apparatus  in 
treatment  of  fracture  of  the  femur.  The  after- 
noon was  spent  in  inspecting  the  Kernan  Hospital 
and  Industrial  School  for  Crippled  Children,  after 
being  entertained  there  at  a  luncheon  given  by 
Dr.  R.  Tunstall  Taylor,  clinical  professor  of  or- 
theopedic  surgery  at  the  University. 


Several  "University-ites"  are  much  amused  be- 
cause of  a  visit  recently  paid  us  by  an  alumnus 
of  about  two  years  ago.  We  understood  that  he 
had  been  piloted  across  the  Styx,  and  had  writ- 
ten "dead"  in  big  letters  across  the  card  in  our 
list  which  bore  his  name.     One  day  recently  he 


Dr.  Murray  P.  Whichard.  class  of  1910,  has 
sent  us  the  following  interesting  letter  in  response 
to  a  query  of  ours  concerning  a  rumor  that  he  had 
moved  to  Porto  Rico.  WTe  think  it  of  sufficient 
interest  to  his  fellow-classmates  to  reproduce  it 
here.    Dr.  Whichard  writes: 

"Dear  Dr.  Winslow: 

"Your  letter  of  inquiry  received  a  few  days 
ago,  and  will  endeavor  to  answer  you  as  best  I 
can.  After  taking  the  North  Carolina  Board  in 
1910  I  came  to  the  extreme  western  section  of 
the  State  and  began  a  rough  country  practice, 
but  soon  landed  a  contract  practice  with  a  big 
lumber  concern,  which  paid  me  a  salary  of  $150 
per  month,  and  was  also  allowed  to  do  a  general 
practice  in  connection ;  but  this  concern  was  of  a 
short  life  and  discontinued  business  after  I  had 
been  with  them  five  months.  I  was  sorry  for  this, 
but  I  know  I  have  gotten  some  valuable  experi- 
ence, which  I  could  not  have  gotten  any  other 
place. 

"I  am  located  in  a  small  mountain  town  of 
about  200  inhabitants,  and  there  is  not  a  physician 
nearer  than  20  miles  in  any  direction,  so  you  see 
I  have  quite  a  large  territory  to  cover,  and  all 
my  work  has  to  be  done  on  horseback,  as  the 
country  is  too  rough  to  use  a  buggy. 

"I  suppose  it  would  shock  Dr.  Neale's  modesty 
to  know  of  one  of  his  students  doing  an  internal 
podalic  version  without  anesthetic  or  assistant 
and  under  conditions  where  asepsis  is  practically 
unknown. 

"This  has  been  my  experience  three  times  in 
the  two  years  I  have  practiced  here,  and  every 
case  recovered  without  even  so  much  as  develop- 
ing a  temperature,  and  it  would  be  difficult  to 
mention  the  number  of  curettements  I  have  done 
without  an  anesthetic. 

"I  also  assisted  Dr.  R.  J.  Oler  in  an  operation 
for  peritonitis  of  10  days  duration  with  the  entire 
abdominal  cavity  filled  with  pus,  with  recovery, 
and  the  interesting  thing  about  the  operation  was 
the  patient  had  a  fecal  fistula,  which  closed  spon- 
taneously three  months  after  the  operation. 

"I  notice  you  state  you  have  heard  I  was  in 


i.iS 


THE    HOSPITAL    BULLETIN 


l'orto  Rico ;  that  is  a  mistake.     I  have  been  in 
North  Carolina  since  I  graduated. 
"Respectfully  yours. 

"M.  P.  Wiiiciiakd." 


Mr.  Howard  Lecates  of  the  senor  class  was  re- 
cently operated  on  for  appendicitis,  but.  we  are 
glad  to  report,  has  entirely  recovered. 

Mr.  E.  Kilbourn  Tullidge  of  the  senior  class 
was  operated  on  recently  in  the  University  Hos- 
pital, deviated  septum,  has  recovered. 


Dr.  Charles  T.  Fisher,  Jr.,  class  of  i<)Oi,  of 
Princess  Anne,  Md.,  was  a  recent  visitor  to  the 
University  Hospital. 


Airs.  Ethel  Palmer  Clark,  superintendent  of 
nurses  in  the  University  Hospital  and  a  member 
of  the  Training  School  for  Nurses,  class  of  1906. 
has  just  returned  from  a  flying  trip  to  Jackson- 
ville, where  she  was  called  on  business. 


A  daughter  was  born  recently  to  Dr.  and  Mrs. 
A.  Aldridge  Matthews  of  Spokane.  Wash.  Dr. 
Matthews  was  a  member  of  the  class  of  1900. 


A  daughter  was  born  recently  unto  Dr.  and 
Mrs.  Eugene  F.  Raphel  of  Fairmont,  YV.  A'a.  Dr. 
Raphel  was  a  member  of  the  class  of  1905. 


Prof.  Randolph  Winslow  will  attend  the  com- 
ing meeting  of  the  Southern  Surgical  and  Gyneco- 
logical Association,  to  be  held  at  Old  Point  Com- 
fort, December  17,  18  and  19.  After  the  conclu- 
sion of  the  meeting  Dr.  Winslow  will  visit  his 
daughter,  Mrs.  Herbert  F.  Carroll,  in  Richmond. 
Virginia. 


Dr.  J.  Mason  Hundley,  class  of  1SS2,  will  also 
attend  the  meeting  of  the  Southern  Surgical  and 
( iynecological  Association. 


Dr.  Nathan  Winslow,  class  of  1901,  was  elected 
president  of  the  University  of  Maryland  Medical 
Societv  at  their  meeting  on  December  10. 


The  basket-ball  team  of  the  University  of  Mary- 
land was  defeated  by  Georgetown  University  on 
Wednesday,  December  11,  by  a  score  of  20  to  18. 
At  the  end  of  the  regular  time  the  score  was  18 
to  iS,  necessitating  an  extra  period  of  five  min- 
utes to  decide  the  winner. 


Dr.  Robert  Bruce  Patrick,  class  of  1912,  is  tak- 
ing a  special  course  at  Johns  Hopkins  Hospital  in 
diseases  of  the  genito-urinary  tract  under  the  di- 
rection of  Dr.  Hugh  H.  Young. 


Dr.  Don  Peters,  a  graduate  of  the  University 

of  Virginia  and  formerly  superintendent  of  the 
Church  Home  and  Infirmary,  has  been  appointed 
an  assistant  in  the  dispensary,  surgical  depart- 
ment, of  the  University  Hospital. 


We  are  glad  to  announce  that,  according  to 
latest  reports,  Dr.  Hemmeter  is  progressing 
nicely. 


UNDERGRADUATE  NOTES 


Under  the  Supervision  of  E.  K.  Tullidge. 


The  Phi  Sigma  Kappa  Fraternity  entertained 
representatives  from  26  universities  and  col- 
leges in  the  United  States  during  its  biennial  con- 
vention, which  was  held  in  Baltimore.  Novem- 
ber 17,  18  and  19. 


The  clinical  assistants  gave  a  smoker  to  the 
internes  and  members  of  the  Senior  faculty  on 
the  eve  of  November  12.  Everyone  thoroughly 
enjoyed  the  event,  and  left  with  a  firm  convic- 
tion of  the  generositv  of  their  hosts. 


Mr.  B.  Karl  Blalock,  after  a  short  illness  in 
the  hospital,  has  recovered  and  is  now  able  to 
resume  his  duties  as  clinical  assistant. 


The  house  men  are  preparing  to  hold  their 
tenth  annual  dance  for  the  Training  School  for 
Nurses. 


The  Latin-American  Club  is  contemplating 
the  purchase  or  erection  of  a  new  clubhouse  near 
the  University. 


The  following  men  have  been  appointed  by 
Editor-in-Chief  Earle  Griffith  Breeding  t>>  serve 
upon  the  staff  of  Terra  Mariae :  Frederick 
Leonard  McDaniel.  Franklin  Clyde  Craven. 
Charles  Reid  Edwards  and  W.  Houston  Toulson. 
all  of  the  senior  class.  Editor  Breeding  request^ 
all  the  members  of  the  senior  classes  of  the  va- 
rious   departments  to  have  their  pictures  taken 


THE    HOSPITAL    BULLETIN 


[99 


with  cap  and  gown  before  December  [8.  He  also 
requests  that  all  class  groups  be  taken  and  handed 
in  to  him  on  or  before  that  date. 


Professor  Ashby  reports  an  excellent  showing 
for  the  senior  class  in  their  re-examinations  in 
October,  but  one  man  having  tailed.  * 


The  Charles  W.  Mitchell  Medical  Society  held 
a  meeting'  on  the  evening  of  November  2j.  Ham- 
ilton J.  Slasher  of  the  senior  class  was  elected 
president   for  the  coming  year. 

The  reception  held  by  the  Kappa  Psi  Frater- 
nity at  their  home,  242  East  Hoffman  street,  mi 
the  evening  of  November  29  was  well  attended. 
Many  of  the  season's  debutantes  were  present. 


At  a  special  meeting  of  the  Randolph  Winslow 
Surgical  Society  held  on  Tuesday  evening.  No- 
vember 26,  1912,  the  following  officers  were 
elected  for  the  ensuing  year:  President,  Earle 
Griffith  Breeding;  vice-president,  E.  Kilbourne 
Tullidge;  secretary,  T.  Ruffin  Pratt;  treasurer. 
Clarence  W.  Judd;  historian,  Robert  Raymond 
Sellers.     All  are  members  of  the  senior  class. 


NU  SIGMA  NU  NOTES. 

The  seventeenth  biennial  convention  of  the  Nu 
Sigma  Nu  Fraternity  was  held  at  the  Hotel  Bel- 
vedere, Baltimore,  November  29  and  30,  under 
the  auspices  of  the  Beta  Alpha  Chapter  of  the 
Cniversity  of  Maryland  and  the  Beta  Beta  Chap- 
ter of  Johns  Hopkins  University. 

About  34  chapters  of  the  medicals  schools  of 
the  United  States  and  Canada  were  represented. 

The  entertainment  consisted  of  a  clinic  given 
Friday  afternoon  by  members  of  the  fraternity 
at  Hopkins.  In  the  evening  a  model  initiation 
was  given  by  Beta  Alpha.  Saturday  morning 
a  clinic  was  given  in  orthopedic  surgery  at  the 
University  of  Maryland  by  Dr.  R.  Tunstall  Tay- 
lor. Dr.  Jose  L.  Hirsh  followed  with  an  interest- 
ing talk  on  luetin  and  its  aid  in  the  diagnosis  of 
syphilis.  Dr.  Hiram  Woods  made  a  short  ad- 
dress on  the  "Conservation  of  Vision."  Follow- 
ing this  a  luncheon  was  served  at  Beta  Alpha 
I  luuse,  816  W.  Lombard  street. 

Tn  the  evening  a  banquet  was  held  at  the  Belve- 
dere. Dr.  Henry  J.  Prentis  of  the  University 
of  Iowa  was  toastmaster,  and  Dr.  Torald  Soil- 


man  of  Western  Reserve  University  and  Dr.  Wil- 
liam Welch  of  Johns  Hopkins  made  the  principal 
addresses.  Dr.  John  C.  Hemmeter,  professor 
of  physiology  and  gastroenterology  in  the  Uni- 
versity, of  Beta  Alpha  Chapter,  was  elected  to 
the  council  officers.  The  convention  then  ad- 
journed to  meet  two  years  hence  in  Philadelphia, 
where  they  will  be  the  guests  of  the  chapters  of 
the  University  of  Pennsylvania  and  the  Jefferson 
Medical  College. 


MARRIAGES 


John  Charles  Norton,  M.D.,  class  of  1912,  of 
Hagerstown,  Md.,  was  married  on  December  3. 
[912,  to  .Miss  Ruth  Cleveland  Atkinson  of  Balti- 
more. The  bride  is  the  daughter  of  Mr.  and 
Mrs.  William  A.  Atkinson  of  322  N.  Fulton  ave- 
nue,  Baltimore,  and  an  accomplished  musician. 

Dr.  and  Mrs.  Norton  were  fellow-students  in 
St.  Martin's  Academy,  where  they  met.  Dr. 
Norton  later  took  a  course  in  pharmacy  in  the 
University  of  Maryland,  and  upon  its  comple- 
tion entered  the  medical  class  of  1912.  He  is  at 
present  practicing  in  Hagerstown,  and  is  assist- 
ant medical  examiner  of  the  Western  Maryland 
Railway  Company. 

The  ceremony  was  performed  at  St.  Martin's 
Catholic  Church  by  the  assistant  pastor,  Rev. 
Carroll  Smythe,  in  the  presence  of  the  imme- 
diate families  and  a  few  intimate  friends.  The 
bride  was  attired  in  a  blue  traveling  suit,  with 
picture  hat  to  match,  and  carried  a  bouquet  of 
chrysanthemums.  She  was  given  in  marriage 
by  her  father.  There  were  no  attendants.  A 
wedding  breakfast  was  served  at  the  residence 
of  the  bride's  parents,  and  the  couple  left  for  a 
Northern  tour.  They  will  be  at  home  after  Janu- 
ary 5  on  the  Washington  Boulevard,  Hagers- 
town. 


DEATHS 


Dr.  William  Hand  Browne,  class  of  1850.  one 
of  the  most  distinguished  alumni  of  the  Univer- 
sity of  Maryland,  died  at  his  home  in  Sherwood. 
Aid.,  on  December  12,  1912,  after  an  illness  of  but 
one  week  of  acute  bronchitis,  aged  S4  years.  Dr. 
Browne,  while  a  graduate  of  the  medical  depart- 
ment, never  practiced  medicine,  and  his  distin- 
guished work  was  done  through  other  channels. 
He  was  born  in  Baltimore  in  1828,  and  graduated 
at  the  University  of  Maryland  in  1850.     He  did 


21  K  ) 


THE    HOSPITAL    BULLETIN 


much  literary  work — was  editor  of  the  Southern 
Review  from  1867  to  1868  and  of  the  Southern 
Magazine  from  1870  to  1875.  His  best  work  was 
done,  however,  as  editor  of  the  State  Archives  of 
Maryland.  All  the  large  libraries  of  England  and 
America  contain  copies  of  this  work,  and  the 
records  of  .Maryland  are  perhaps  more  complete 
than  those  of  any  other  of  the  thirteen  original 
States. 

Dr.  Browne  has  been  known  for  many  years  as 
one  of  Maryland's  most  scholarly  and  cultured 
men.  Among  his  widely  read  and  known  books 
are  his  "Maryland — The  History  of  a  Palatinate  ;" 
"I  ieorge  and  Cecilius  Calvert,  Barons  of  Balti- 
more," and  "Life  of  Alexander  II.  Stephens." 
He  compiled,  in  collaboration  with  Col.  Richard 
.Malcolm  Johnston,  the  '"Clarendon  Dictionary  of 
the  English  Language."  He  also  translated  many 
( ierman  and  French  works  into  English,  and 
edited  "The  Trail  of  Rauf  Coilyear,"  a  Scottish 
metrical  romance  of  the  fifteenth  century.  At  the 
time  of  his  death  he  was  professor  emeritus  of 
English  literature  of  the  Johns  Hopkins  Univer- 
sity. He  was  librarian  of  the  Hopkins  from  1879 
to  1891,  being  the  second  to  fill  that  office.  At  the 
time  he  became  librarian  the  library  contained  but 
7000  books ;  at  the  time  of  his  resignation  it  con- 
tained over  40,000  volumes.  In  1880  he  was  ap- 
pointed associate  in  English  literature,  in  1891  as- 
sociate professor,  and  became  the  head  of  the  de- 
partment in  1893,  resigning  in  June,  1910.  His 
kindly  sympathy,  ready  wit  and  great  learning 
endeared  to  him  his  many  students,  and  his  ad- 
vice was  always  eagerly  sought. 

His  wife  died  some  years  ago.  She  was  Miss 
Mary  Catherine  Owings  of  Baltimore.  His  chil- 
dren, all  of  whom  were  with  him  when  he  died, 
are  Dr.  Arthur  Lee  Browne,  Mrs.  Charles  W. 
Hoff,  Miss  Lucy  H.  Browne,  all  of  Baltimore ; 
Prof.  William  Hand  Browne,  Jr.,  of  the  North 
Carolina  Agricultural  and  Mechanical  College, 
Raleigh,  N.  C,  and  Sidney  H.  Browne  of  New 
York.  The  pallbearers  were  selected  from  his 
most  intimate  friends  and  associates.  They  were 
Prof.  Basil  L.  Gildersleeve,  Dr.  James  W.  Bright. 
Dr.  E.  C.  Armstrong,  Dr.  E.  H.  Griffin,  H  Oliver 
Thompson,  Dr.  Bernard  C.  Steiner,  Clayton  C. 
Hall,  Edward  Lucas  White,  Henry  Kellogg  and 
1  )r.  Cecil  Dabney. 

Dr.  Browne  was  an  authority,  even  in  his  stu- 
dent <lays,  on  matters  concerning  the  history  of 
Maryland  and  the  South.  He  loved  the  country 
and   spent  as  much   time  as  possible  there,  and 


much  of  his  work  was  done  in  the  library  of  his 
home  in  Rnxton.  He  made  several  trips  to  Eu- 
rope, but  was  not  an  ardent  traveler.  He  was 
very  fond  of  music  and  a  performer  of  consider- 
able skill  on  the  flute.  Sidney  Lanier,  the  poet,  at 
his  death,  left  his  flute  to  Dr.  Browne,  and  he 
loved  to  use  it.    According  to  the  Baltimore  Sun: 

"Music,  reading  and  walks  through  the  country 
about  his  home  constituted  his  recreation  during 
the  closing  years  of  his  life ;  in  the  summer  of 
ii.il  1  he  told  his  friend,  Professor  Gildersleeve, 
that  he  had  just  finished  reading  Livy  from  cover 
to  cover  as  a  means  of  passing  the  time  pleasantly. 
He  possessed  great  facility  in  composing  verse, 
and  this  served  as  a  congenial  occupation  during 
his  leisure  moments. 

"The  late  Rev.  John  B.  Tabb,  the  poet-priest 
and  professor  of  English  at  St.  Charles'  College, 
was  a  great  admirer  and  a  warm  friend  of  Dr. 
Browne.  When  Father  Tabb  died  a  few  years 
ago  there  were  few  who  mourned  for  him  more 
than  did  Dr.  Browne.  The  priest  and  the  his- 
torian often  took  trips  together,  and  were  closeted 
for  hours  in  heart-to-heart  talks.  Father  Tabb, 
who  enjoyed  the  reputation  of  being  one  of  the 
leading  educators  in  English  in  this  country,  al- 
ways went  to  Dr.  Browne  whenever  there  was  a 
dispute  over  any  question  in  that  branch,  and  his 
decision  was  accepted  as  infallible. 

"Dr.  Borwne  was  a  leading  member  of  the 
Maryland  Historical  Society  and  of  the  Sons  of 
the  American  Revolution,  and  his  contributions  to 
the  historical  lore  of  those  bodies  were  of  great 
value. 

"An  inaccuracy  that  aroused  the  resentment  of 
the  historian  was  the  use  of  black  and  orange  as 
the  colors  of  Maryland.  The  proper  colors  are 
black  and  gold,  he  always  declared  with  much  em- 
phasis, and  was  always  ready  to  explain  their 
heraldic  significance. 

His  death  marks  the  passing  of  another  of  the 
University's  great  sons  to  the  ranks  of  the  im- 
mortals. Dr.  Browne  was  perhaps  the  most  dis- 
tinguished alumnus  of  the  medical  school  who  won 
his  laurels  in  other  lines,  and  in  the  world  of 
literature  and  education  his  worth  will  be  long 
remembered.  Of  the  great  company  of  well- 
known  men  who  studied  in  our  Alma  Mater  in 
those  earlier  days  before  the  Civil  War,  there  are 
now  but  a  handful  left.  We  mourn  deeply  their 
going,  but  rejoice  in  the  work  that  Maryland's 
sons  are  leaving  behind  for  the  world  to  remem- 
ber. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 
PRICE    $1.00    PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  608  Professional  Building,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.  VIII 


BALTIMORE,  MD.,  JANUARY  IS,   1913 


No.  11 


REPORT  OF  A  CASE  OF  BRONCHI  >S- 
COPY  FOR  MULTIPLE  FOREIGN 
BODIES  (ALMOND  SHELL  AND 
PULP)  IN  A  CHILD  TWO  YEARS  OF 
AGE.  WITH  SOME  OBSERVATIONS 
UPON  BRONCHOSCOPY  IN  INFANTS 
AND  YOUNG  CHILDREN.* 


By  John  R.  Win-slow.  B.A.,  M.D., 

Clinical    Professor    Nose    and    Throat    Diseases 

in  the  University  of  Maryland. 


On  January  5,  191 1,  at  2  P.  M.,  in  accordance 
with  a  telegraphic  appointment,  I  met  Dr.  F.  ( 1. 
Wright  of  Chambersburg,  Pa.,  at  the  University 
Hospital  in  consultation  upon  the  case  whose  his- 
tory follows : 

Iona  B.,  aged  two  years,  was  playing  upon  the 
floor  two  days  previously  when  her  mother's  at- 
tention was  attracted  by  her  crying,  and  she 
noticed  that  the  child  was  blue  in  the  face  and 
breathing  badly.  She  immediately  held  the  child 
up  by  its  feet,  slapped  her  back,  and  running  her 
finger  down  the  throat  removed  a  large  amount 
of  almond  shell  and  pulp.  This  resulted  in 
greatlv  improved  respiration,  and  the  mother  sup- 
posed that  the  nut  had  all  been  removed. 

Since  this  time,  however,  the  child  has  at  times 
exhibited  embarrassed  respiration  and  occasion- 
ally cyanosis. 

Examination.  —  Respiratory  movements  much 
shallower  on  left  side  and  respiratory  sounds  lost 
below  the  second  rib :  no  rales  present ;  tempera- 
ture, 98^°;  pulse.  ri8;  respiration,  28;  slight 
supraclavicular  retraction  on  left;  right  lung 
normal. 

The  patient  was  admitted  to  the  University 
Hospital  and  the  larynx  examined  under  cocaine 


'Abstracted  from  paper  presented  to  the  American  Laryn- 
gological  Association  at  its  Annual  Meeting  in  Atlantic 
City,  X.  J.,  May,  1912. 


with  the  direct  Jackson's  speculum.  Nothing  was 
seen  in  the  glottic  nor  subglottic  space,  and  real- 
izing the  impossibility  of  passing  a  bronchoscope 
through  a  larynx  of  such  size  without  undue 
force,  tracheotomy  was  determined  upon. 

Meanwhile  a  radiograph  was  obtained,  which, 
as  was  to  be  expected  from  the  nature  of  the  ob- 
ject (nut),  revealed  no  foreign  body,  but  only 
enlarged  peribronchial  glands. 

On  January  6,  191 1,  at  3  P.  M.,  I  performed  a 
low  tracheotomy,  assisted  by  Dr.  F.  G.  Wright, 
under  chloroform  anesthesia. 

Immediately  subsequently,  with  Dr.  II.  C.  Da- 
vis in  charge  of  the  patient's  head  and  the  bron- 
choscopes, I  passed  a  7  mm.  Jackson's  tube  into 
the  left  lower  lobe  bronchus,  which  was  sys- 
tematically examined.  The  tube  was,  however, 
too  large  to  enter  the  upper  lobe  bronchus.  A 
considerable  amount  of  milky  pulp  was  found  in 
the  bronchus  and  removed  with  mops;  no  shell 
could  be  discovered. 

I  had  expected  to  employ  suction  with  Killian's 
aspirator,  in  the  hope  of  aspirating  the  material 
from  the  smaller  bronchus,  but  the  patient  became 
cyanotic,  the  pulse  weak,  and  oxygen  and  amyl 
nitrite  had  to  be  administered. 

The  bronchoscopic  examination  was  of  neces- 
sity discontinued,  having  occupied  about  30 
minutes. 

The  tracheotomy  wound  was  left  open,  long 
sutures  were  inserted  in  the  lip,  and  the  nurse  in- 
structed to  pull  the  wound  open  should  the  patient 
cough. 

The  following  day  (January  7)  the  tempera- 
ture shot  up  to  103. 40  F. ;  respiration,  140.  Em- 
barrassed respiration,  diminished  resonance,  with 
loss  of  inspiratory  and  expiratory  murmur  below 
the  second  rib,  were  present  on  left  side  ;  tubular 
breathing  was  heard  at  left  apex. 

Subsequently  marked  cough  with  expectoration 


202 


THE    HOSPITAL    BULLETIN 


developed.  In  short,  the  patient  manifested  well- 
marked  pneumonia. 

At  this  period  Dr.  C.  W.  McElfresh  was  called 
in  consultation  and  placed  in  charge  of  the  med- 
ical treatment  of  the  case. 

From  the  9th  to  the  15th  the  patient  went 
through  the  varying  phases  of  a  typical  pneu- 
monia. 

On  January  13  the  tracheotomy  tube,  which 
had  been  inserted  the  day  following  the  operation, 
was  permanently  removed,  and  the  patient  was 
able  to  breathe  through  the  mouth  readily. 

On  January  17,  the  thirteenth  day,  the  patient 
was  discharged  from  the  hospital  to  return  home ; 
temperature,  97.30;  pulse,  no;  respiration,  ,24. 
Tracheotomy  wound  nearly  closed ;  general  con- 
dition much  improved.  The  subsequent  history 
of  the  case  is  derived  from  two  letters  sent  by 
Dr.  Wright.  The  first,  dated  February  16,  191 1, 
reports : 

"Dear  Doctor — The  child  is  still  alive,  but  very 
ill.  When  she  first  came  home  she  was  very  well, 
except  a  running  ear  and  a  solid  patch  a  little 
larger  than  a  silver  dollar  in  the  left  apex.  It 
seemed  as  though  the  trouble  would  subside  and 
the  foreign  body  become  encapsulated,  but  she 
developed  an  influenza  (everyone  here  has  it), 
and  after  a  week  of  coughing  developed  a  pneu- 
monia involving  at  least  the  whole  of  the  upper 
left  lobe.  After  having  the  pneumonia  one  week 
the  scar  in  the  trachea  opened  spontaneously,  and 
I  opened  the  skin,  allowing  a  free  discharge.  The 
next  day  she  coughed  up  an  oval  piece  of  almond 
kernel  about  6x3  m.m.  That  was  four  or  five 
days  ago,  and  she  is  slightly  improving.  If  she 
gets  well,  will  send  full  data.  Wright." 

An  extract  from  the  second  letter,  dated  Feb- 
ruary 29,  1 91 2,  gives  the  final  outcome  of  the 
case: 

"Dr.  John  Winslow : 

''Dear  Doctor — Today  I  examined  lona  B. 
The  child  is  apparently  perfectly  well,  with  no 
signs  to  show  where  the  trouble  in  the  chest  was. 

"The  scar  in  the  neck  is  rather  broad,  but  the 
trachea  seems  solid.  After  a  slow  convalescence 
she  recovered  fully.       Very  truly  yours, 

"Fairfax  G.  Wright." 

A  more  unfavorable  case  could  scarcely  be 
imagined  than  this  one,  presenting  many  diffi- 
culties: 


1.  The  child's  age  (two  years)  and  under- 
development. 

2.  The  nature  of  the  foreign  body,  a  pulpified 
nut,  furnishing  multiple  particles  which  were 
splattered  all  over  the  lung  surface,  and  doubtless 
entered  every  bronchiole. 

3.  The  bronchus  involved,  the  left,  the  most 
difficult  to  examine. 

I  have  hesitated  whether  to  call  this  a  success- 
ful or  an  unsuccessful  case.  While  technically  I 
did  not  succeed  in  removing  all  of  the  foreign 
body  by  bronchoscopic  methods,  yet  I  am  firmly 
convinced  that  had  the  nut  pulp  not  been  removed 
from  the  main  bronchus,  tracheotomy  alone  would 
not  have  enabled  the  child  to  clear  its  lung  and 
survive  the  first  pneumonia. 

From  a  life-saving  standpoint  the  case  was 
most  successful,  and  one  in  whose  outcome  every- 
one concerned  has  reason  to  feel  gratified. 

The  pathologic  condition  in  such  a  case  is  well 
illustrated  in  that  reported  by  F.  E.  Hopkins 
(Transactions  American  Laryngological  Associa- 
tion, 191 1 ). 

A  female  child,  four  years  of  age,  inhaled  a 
peanut.  Careful  bronchoscopic  examination  at 
two  sittings  failed  to  reveal  a  foreign  body,  and 
the  child  died  on  the  second  day. 

"Autopsy  showed  many  (24)  small  fragmants 
of  nuts  scattered  throughout  the  lungs  and 
around  each  a  pneumonic  area. 

"Instead  of  a  single  nut  occluding  the  trachea 
or  larger  bronchi,  the  many  fragments  of  the 
well-chewed  nut  were  shot  into  the  smaller 
bronchi." 

Thomas  Hubbard  reports  similar  autopsy  find- 
ings (ibid.)  in  a  peanut  case  in  his  practice. 

Cases  of  foreign  bodies  in  the  lungs  of  young 
children  and  infants  (say  of  four  years  and  un- 
der) are  coming  under  our  care  in  increasing 
numbers,  because  through  the  writings  of  Kil- 
lian,  Jackson,  Ingals,  Coolidge,  Halsted,  Mosher, 
Hubbard  and  other  masters  of  bronchoscopy  the 
general  profession  is  being  educated  to  recognize 
these  conditions  and  their  proper  method  of  treat- 
ment. 

These  cases  constitute  the  most  difficult  in  the 
whole  field  of  bronchoscopy,  both  on  account  of 
the  small  size  of  the  respiratory  passages  at  this 
period  of  life  and  the  difficulties  of  instrumental 
manipulation,  as  well  as  the  nature  of  the  objects 
usually  encountered. 


THE   HOSPITAL   BULLETIN 


203 


While  a  young  child  is  liable  to  place  almost 
anything  in  the  mouth  and  inhale  it,  owing  to  the 
small  size  of  the  glottis  (6  mm.  infants,  Jackson; 
7  mm.  3  years,  Killian),  large  objects  cannot  pass 
through  into  the  lower  passages.  Therefore, 
many  of  the  foreign  bodies  commonest  in  adults 
are  rarely  found  in  the  lungs  of  very  young  chil- 
dren (pieces  of  bone),  while  those  encountered 
belong  to  the  class  most  difficult  of  removal — ■ 
small  or  multiple  objects  (nut  shells,  pulp,  beads, 
pins,  beans,  pebbles,  etc.). 

The  younger  the  child  the  greater  the  difficulty 
and  urgency,  and  the  mortality  is  high,  despite 
successful  removal.  So  that  it  has  seemed  to  me 
that  these  cases  constitute  a  group  of  themselves 
well  worthy  of  the  discussion  of  this  representa- 
tive body,  and  for  this  purpose  I  have  brought  the 
subject  before  you. 

What  is  our  best  course  of  procedure  in  this 
class  of  cases  ?  Should  we  tracheotomize  at  once 
as  the  primary  procedure,  or  has  the  advent  of 
bronchoscopy  largely  abolished  the  necessity  for 
this  operation? 

The  desirability  of  upper  bronchoscopy  (with- 
out tracheotomy)  is  obvious,  and  it  should  be  the 
routine  method  were  there  no  disadvantages  as- 
sociated with  it. 

In  prebronchoscopic  days  tracheotomy  was  the 
method  of  choice,  whose  success  is  attested, 
among  numerous  others,  by  the  remarkable  series 
of  four  cases  of  foreign  bodies  in  the  bronchi  of 
small  children  under  two  and  one-half  years  of 
age,  reported  by  our  fellow,  T.  H.  Halsted 
(  Transactions  American  Laryngological,  Rhino- 
logical  and  Otological  Society,  1902). 

In  these  young  children  upper  bronchoscopy 
has  serious  objections  attached  to  it.  The  ana- 
tomical structures  are  small,  rendering  the  ma- 
nipulation of  instruments  difficult  and  resulting 
in  loss  of  time  and  irritation  of  tissues. 

A  study  of  the  cases  reported  show  that  while 
upper  bronchoscopy  has  been  frequently  at- 
tempted for  the  removal  of  foreign  bodies  in 
infants,  in  a  large  percentage,  if  not  the  majority 
of  the  cases,  tracheotomy  has  become  ultimately 
necessary  for  successful  removal. 

Now,  if  such  be  the  situation,  why  not  tracheot- 
omize at  once  and  operate  by  the  easier  and  more 
certain  route  (lower  bronchoscopy)  ? 

In  a  recent  article  (Dcutsch.  mcd.  IVoclien- 
schrift.  June  29,   191 1)    G.  Killian  has  made  a 


most  valuable  contribution,  in  which  he  calls  at- 
tention to  another  aspect  of  this  subject,  namely, 
the  frequency  with  which  tracheotomy  or  intuba- 
tion becomes  necessary  after  upper  bronchoscopy, 
even  when  successful  reporting  a  series  of  19 
cases  under  seven  years  of  age,  some  of  them  per- 
sonal and  some  derived  from  literature.  He  also 
cites  a  series  of  35  cases  reported  by  Schneider 
of  Moscow,  of  which  five  required  intubation  or 
tracheotomy.  He  concludes  that  these  procedures 
stand  in  a  causal  relation  to  upper  bronchoscopy, 
inasmuch  as  the  changes  necessitating  them  oc- 
cur within  a  relatively  short  period  (6-37  hours) 
afterward ;  that  the  site  of  the  change  is  the  sub- 
glottic space,  as  evidenced  by  the  stridor  and  the 
results  of  intubation  or  tracheotomy,  and  in  a  few 
cases  by  direct  or  indirect  laryngeal  examination. 

We  know  from  both  clinical  experience  and 
post-mortem  evidence  that  inflammatory  swell- 
ings are  prone  to  occur  in  the  subglottic  space. 
Children  from  the  seventh,  and  especially  from 
the  fourth,  year  downwards  are  especially  liable 
to  such  swellings  after  upper  bronchoscopy. 

The  selection  of  method  must  be  individual, 
depending  upon  a  number  of  considerations. 

1.  Age  of  the  patient.  As  Killian  has  demon- 
strated, it  is  more  a  matter  of  physical  development 
than  of  age ;  nationality  also  may  have  a  bearing. 
At  least  my  intubation  experiences  have  shown 
me  that  in  certain  nationalities  (Italian)  the 
larynx  is  smaller  than  the  corresponding  age. 

Some  years  ago  Ingals  announced  that  he  had 
rarely  found  upper  bronchoscopy  satisfactory  in 
children  under  three  years  of  age. 

Recently  Finder,  apropos  to  an  unsuccessful 
case  of  a  piece  of  bone  in  the  right  bronchus  of 
an  1 1 -months-old  child,  reported  to  the  Berlin 
Laryngological  Society,  stated  that  henceforth  he 
will  resort  to  inferior  bronchoscopy  in  all  children 
in  the  first  year  of  life. 

In  discussing  this  case  E.  Meyer  went  still  fur- 
ther, and  considers  inferior  bronchoscopy  prefer- 
able in  children  six  years  of  age  and  under. 
Briining  advises  it  in  all  children  under  two  years 
of  age  as  a  routine  procedure. 

Xehrkorn  recommends  low  bronchoscopy  in  all 
young  children. 

Jackson,  however,  regards  tracheotomy  as  be- 
ing "unnecessary  nine  times  out  of  ten,"  and  be- 
lieves that  it  should  be  limited  to  dyspneic  cases. 


204 


THE    HOSPITAL    BULLETIN 


I  should  like  to  know  whether  he  intends  this  to 
apply  to  these  very  young  children. 

2.  The  nature  of  the  foreign  body  is  of  great 
importance  in  determining  this  question. 

Objects  which  are  liable  to  swell  so  that  they 
cannot  be  withdrawn  through  the  subglottic  space 
(beans)  should  be  removed  by  the  lower  route 
(Nehrkorn,  Killiau). 

Likewise  brittle  objects,  which  are  liable  to  be 
broken  into  several  fragments,  or  multiple  ob- 
jects, necessitating  a  great  deal  of  manipulation; 
objects  which  are  irritating  in  themselves  and  cer- 
tain to  be  followed  by  pulmonary  inflammation 
(peanut  shells,  pepper  corns),  should  be  removed 
without  irritation  of  the  subglottic  space  by  in- 
struments. 

3.  The  duration  of  the  condition  is  of  a  de- 
termining moment.  The  presence  of  a  foreign 
body  rapidly  produces  a  catarrhal  condition  of 
the  air  passages  in  children,  increasing  the  vul- 
nerability of  the  mucous  membrane  to  instrumen- 
tal manipulation.  Therefore,  when  the  foreign 
body  has  remained  for  a  long  time,  tracheotomy 
is  indicated  (E.  Meyer.  Killian). 

4.  The  side  affected  must  be  considered,  for 
it  is  much  more  difficult  to  remove  a  foreign  body 
from  the  left  bronchus,  especially  by  upper  bron- 
choscopy. Among  13  cases  in  children  collected 
by  Killian,  in  nearly  two-thirds  the  foreign  body 
was  found  in  the  left  bronchus. 

5.  The  condition  of  the  subglottis  space  is  of 
paramount  importance.  This  should  always  be 
determined  by  direct  or  indirect  laryngeal  exami- 
nation before  undertaking  upper  bronchoscopy. 

Any  outspoken  subglottic  swelling  constitutes 
a  contraindication  to  upper  bronchoscopy. 

The  passage  of  the  bronchoscopic  tube  will  in- 
evitably result  in  the  necessity  for  the  tracheot- 
omy. It  is,  therefore,  better  to  perform  this  oper- 
ation primarily  and  employ  lower  bronchoscopy. 

In  conclusion,  it  seems  to  me  that  the  present 
situation  with  regard  to  foreign  bodies  in  the 
lungs  of  young  children  has  been  well  sum- 
marized in  the  advice  of  Hubbard:  "When  in 
doubt  do  tracheotomy." 

REFERENCES. 

Halstead,  T.  H.,  Transactions  American  Laryn- 
gological,  Rhinological  and  Otological  Society, 
1902. 

Killian,  (i.,  Transactions  Laryngological,  Rhin- 
ological and  Otological  Society,  1907. 


Killian,  G.,  Dcutsch.  med.  Woch.,  June  29, 
1911. 

Briinings,  W.,  Zeitschr.  fur  Ohrcnheilk.,  De- 
cember, 1910. 

Finder.  J'crhandl.  dcr  Laryug.  Gcscllsch.  zu 
Berlin,  191 1. 

Meyer,  E.,  Verhandl.  dcr  Laryug.  Gcscllsch. 
~u  Berlin,  191 1. 

Hubbard,  Thomas,  Transactions  American 
Laryngological  Association,  191 1. 

Jackson,  Chevalier,  Transactions  American 
Laryngological  Association,  191 1   (discussion). 

Hopkins,  F.  E.,  Transactions  American  Laryn- 
gological Association,  191 1. 


FIRST    AID    TO    THE    INJURED    WITH 
SPECIAL  REFERENCE  TO  SHOCK. ;: 


By  Roscoe  McMillan,  M.D.  (1910). 

Local  Surgeon,  A.  C.  L.. 

Red  Springs,  N.  C. 


Mr.  President,  Ladies  and  Gentlemen: 

We  can  scarcely  wonder  that  accidents  are  in- 
creasing from  year  to  year  when  we  stop  to 
consider  the  increase  in  rapid  locomotion  of 
many  kinds,  the  factories,  mines,  workshops, 
railroads,  etc.,  all  over  the  country.  While  the 
ratio  of  accidents,  compared  with  the  number 
of  employes,  is  not  increasing,  the  total  number 
of  accidents  are  increasing  every  year.  A  recent 
report  from  the  Interstate  Commerce  Commis- 
sion says,  "Accidents  on  the  railroad  seem  to  be 
increasing  steadily." 

The  nature  of  employment,  surroundings  and 
method  of  conducting  the  work  determine  the 
number  of  injuries.  There  is  no  doubt  the 
actual  number  of  fatal  cases  resulting  from  in- 
juries will  be  greatly  lessened  by  prompt  and 
skilful  treatment. 

In  this  brief  article  I  am  exerting  my  energies 
toward  railway  accidents  entirely.  I  am  glad  to 
say  nearly  every  large  railroad  company  has  its 
own  surgical  staff.  As  I  stand  today  looking 
into  your  faces,  I  am  thoroughly  convinced  the 
Atlantic  Coast  Line  has  a  very  select,  well- 
equipped  and  competent  surgical  staff,  ready  to 
meet  any  and  all  emergencies  as  they  arise.  But. 
gentlemen,  it  is  a  well-known  fact  that  it  is  im- 
possible for  a  surgeon  to  be  delegated  to  every 


•Read  by  title  before  Atlantic  Coast  Line  Surgeons    Asso- 
ciation, Richmond,  Va.,  October  ij.  1912. 


THE   HOSPITAL   BULLETIN 


205 


train  on  the  railroad,  and  as  it  happens  all  ac- 
cidents do  not  happen  at  an  appointed  time  or 
place  when  the  surgeon  can  be  at  the  scene  of 
trouble.  But  it  is  possible  for  every  road  to  have 
its  responsible  employes  systematically  taught 
the  elementary  principals  of  first  aid  to  the  in- 
jured, especially  the  great  importance  of  con- 
trolling hemorrhage,  protecting  an  open  wound, 
and  even  so  far  as  relieving  a  broken  limb  to 
some  extent,  pending  the  arrival  of  a  surgeon. 
I  know  a  lack  of  knowledge  of  some  of  these 
elementary  principals  is  in  a  great  measure  re- 
sponsible for  loss  of  life.  Every  railroad  should 
be  compelled  by  law  to  carry  first-aid  packets  on 
every  train,  and  more  should  be  placed  at  sta- 
tions on  the  road.  These  packets  should  consist 
of  at  least  two  rubber  tourniquets,  a  package  of 
aseptic  gauze,  absorbent  cotton,  half  dozen  mus- 
lin bandages  of  different  widths,  adhesive  plaster 
and  a  bottle  of  antiseptic  tablets. 

Injuries  on  the  railroad  are  peculiar  only  in 
their  great  severity  and  varied  character.  On 
this  account,  and  because  of  the  horror  so  com- 
monly preceding  and  attending  these  injuries, 
there  is,  as  a  rule,  more  shock  from  these  than 
from  any  other  class  of  injuries.  There  are  few 
problems  of  more  interest  to  the  railroad  sur- 
geon than  shock.  In  railroad  accidents,  where 
we  have  to  deal  with  fractures,  dislocations, 
lacerated  wounds,  etc.,  we  have  to  deal  with  a 
lowered  condition  of  all  the  vital  functions  of 
the  body,  especially  of  the  circulatory  system. 
It  is  a  critical  moment  to  see  patients  lying  be- 
side the  track,  or  wherever  they  may  be,  with  a 
small  thready  pulse,  a  lowered  condition  of 
respiration  (may  be  full,  fast  or  slow),  blanched 
skin  and  mucous  membranes,  skin  cold  and  clam- 
my, muscles  relaxed,  eyes  sunken,  mouth  half 
open  and  absolutely  indifferent  and  careless  as 
to  their  surroundings. 

It  is  needless  to  say,  gentlemen,  the  condition 
calls  for  immediate,  wise  and  conservative  ac- 
tion.   There  are  several  different  forms  of  shock. 

First. — Psychic  shock.  This  is  produced  by 
emotion ;  it  is  a  condition  brought  about  by  the 
terror  a  conscious  person  has  of  a  seemingly  in- 
evitable and  terrible  accident.  This  usually  pre- 
cedes the  injury;  sometimes  there  is  no  injury 
at  all,  still  the  condition  is  found. 

Second. — Injury  to  nervous  system. 

Third. — Hemorrhage  causing:  shock. 


The  first  thing  to  do  in  all  cases  is  to  find  out 
what  has  caused  the  shock  and  try  to  lessen  any 
further  shock  by  removing  the  cause  if  possible. 
See  at  once  if  all  bleeding  has  been  controlled ; 
if  hemorrhage  continues,  this  must  be  controlled 
first.  Then  ascertain  the  physical  condition  of 
patient.  Inexperienced  surgeons  are  frequently 
so  anxious  to  attend  to  the  wounds,  they  entirely 
neglect  the  wounded  person.  They  go  through 
the  very  long,  but  proper,  aseptic  technique  neces- 
sary for  the  local  injury,  and  are  very  much  sur- 
prised on  completing  the  dressing  to  find  the 
patient  is  dead. 

The  absence  of  any  serious  wound  to  the  head 
or  spinal  column,  and  the  fact  that  no  great 
hemorrhage  has  taken  place  externally  or  in- 
ternally suggests  psychic  shock.  For  this  form 
restore  heat  to  the  surface  and  give  full  doses  of 
morphia  and  atropine  hypodermatically,  which 
will  in  a  great  measure  diminish  the  urgency  of 
symptoms. 

The  second  and  last  forms  are,  of  course,  more 
serious  and  difficult  to  treat.  The  wounded  sur- 
faces should  be  handled  very  carefully  on 
account  of  the  psychic  effect  of  pain;  also  on 
account  of  the  production  of  dangerous  shock- 
producing  afferent  impulses  that  attend  manipu- 
lation of  tissues  having  a  nerve  supply.  Support 
the  circulation ;  give  moderate  doses  of  strych- 
nine, or  digitalis,  ammonia,  caffeine,  ergot,  etc., 
frequently  repeated.  Each  and  every  case  must 
be  treated  as  a  case  unto  itself.  Alcohol  will 
sometimes  tide  over  a  bad  case  temporarily,  but 
continued  large  doses  do  more  harm  than  good. 
Support  circulation  mechanically  by  use  of  sa- 
line infusion;  the  only  trouble  is  to  obtain  sterile 
water.  If  possible,  use  at  least  500  c.c.  of  nor- 
mal salt  solution,  to  which  at  least  15  c.c.  of  a  1 
to  1000  solution  of  adrenalin  chloride  has  been 
added.  This  should  be  given  subcutaneously  and 
repeated  as  necessary.  In  severe  cases  bandage 
the  abdomen  and  extremities  to  force  the  blood 
into  the  heart,  head  and  lungs.  Make  patient 
as  comfortable  as  possible.  Secure  absolute 
rest,  both  mentally  and  physically.  .  Gain  pa- 
tient's confidence,  calm  his  fears;  if  this  cannot 
be  done,  use  small  amount  of  some  anodyne. 

I  believe  in  delaying  operations  while  pa- 
tient's condition  is  not  so  good,  but  if  we  do  de- 
lay we  must  see  that  the  wound  is  clean.  Wash 
it  until  you  know  it  is  clean,  then  twice  as  long 
again. 


206 


THE    HOSPITAL    BULLETIN 


REPORT   OF   FOUR   UNUSUAL   CASES.* 


By  A.  At.dridge  Matthews,  M.D., 
Spokane,  Wash. 


I  think  it  would  be  a  good  policy  for  members 
of  our  Society  to  make  it  a  point  to  report  cases 
which  are  interesting  or  unusual.  There  are 
many  conditions  which  are  acceded  as  being  rare 
from  the  records,  but  in  reality  are  as  a  whole 
common,  so  common  that  they  are  not  worth  while 
to  make  record  of  ;  the  acute  emergency  gall  blad- 
der work,  ruptured  pyosalpinx,  causing  general 
peritonitis,  foreign  body  appendicitis,  other  than 
due  to  fecal  concretions  and  such. 

I  take  this  opportunity  to  report  four  cases,  one 
of  ruptured  pyosalpinx,  causing  general  perito- 
nitis, and  three  cases  of  appendicitis,  one  being 
due  to  an  ordinary  brass  pin,  one  to  an  apple  seed 
and  one  pin  worms.  I  was  prompted  to  do  so  by 
reading  articles  by  W.  N.  Buckman  and  R.  H. 
Fowler,  both  of  New  York,  and  from  whose 
papers  I  take  the  liberty  to  quote  as  regards 
statistics  which  they  have  compiled. 

The  first  report  will  be  the  ruptured  pyosalpinx, 
but  before  reporting  will  run  over  briefly  some 
data  that  I  have  gathered  on  the  subject. 

There  have  been  recorded  but  91  cases  of  rup- 
tured tubal  or  ovarian  abscesses,  causing  general 
peritonitis,  and  adding  my  one  case,  making  92. 
While  this  is  the  first  case  of  this  character  I  have 
ever  seen,  although  I  had  the  opinion  that  it  was 
much  more  common  in  so  frequent  a  disease  as 
pyosalpinx,  92  instances  of  ruptured  tube  and  dif- 
fuse peritonitis  are  few  enough  indeed  to  warrant 
the  belief  that  this  complication,  if  not  rare,  is  at 
any  rate  unusual.  On  the  other  hand,  if  one 
could  add  to  these  92  the  unrecorded  cases,  the 
reports  buried  here  and  there  in  the  literature  and 
the  instances  of  perforation  protected  by  localized 
peritonitis,  the  figures  would  be  large  enough,  no 
doubt,  to  show  that  rupture  is  a  complication  too 
infrequent  to  gainsay  conservative  treatment  of 
pyosalpinx,  but  sufficiently  common  to  be  born  in 
mind  in  the  management  of  every  case  of  purulent 
tubal  infection. 

Of  the  92  cases  recorded,  many  were  post- 
mortem notes,  and  in  many  the  history  is  very 
meager.  Therefore  the  literature  of  this  lesion  is 
not   susceptible    to   complete   statistical   analysis. 


•Read  before  Spokane   Countv    Medical   Society,   November, 
1912. 


Thirty-six  of  these  cases  were  not  operated  upon, 
all  died,  and  from  the  autopsy  findings  the  diag- 
nosis was  made.  Forty-six  were  operated  upon, 
36  recovered  and  10  died. 

The  diagnosis  of  these  conditions  is  not  at  all 
an  easy  matter,  and  one  has  to  consider  the  per- 
son's history.  The  most  common  mistake  is  to 
call  it  appendicitis,  and  it  can  well  be  associated 
with  it  or  ectopic  gestation.  The  anatomic  diag- 
nosis is  not  essential,  however,  since  peritonitis  is 
usually  evident ;  the  indication  for  operation  is 
therefore  established. 

It  is  of  interest  to  note,  in  looking  up  the  rec- 
ords of  such  cases,  there  is  a  history  of  repeated 
attacks  of  severe  pain  before  the  onset  of  the 
peritonitis,  the  final  attack  being  the  most  severe, 
and  followed  by  collapse  and  the  peritonitis. 

The  diagnosis  of  peritonitis  due  to  a  ruptured 
hollow  organ  is  easily  provided  by  history  of  sud- 
den violent  pain  and  collapse  or  weakness,  fol- 
lowed by  great  or  entire  relief  of  pain  and  the 
development  of  peritonitis  signs  and   symptoms. 

Toward  the  recognition  of  a  ruptured  pus  tube 
as  the  source  of  such  a  peritonitis,  the  most  im- 
portant thing  to  bear  in  mind  is  its  occasional 
occurrence  and  to  consider  it  as  about  fifth  in  role 
of  rupturing  organs  following  the  appendix,  gall 
bladder,  bowel  and  stomach.  Localization  of  pain 
and  tenderness  low  down  in  the  iliac  region,  the 
history  of  gonorrhea  or  a  recent  pregnancy  or 
uterine  instrumentation  fortify  us,  especially  if 
there  is  a  great  tenderness  and  a  mass  or  fullness 
in  the  vaginal  fornix,  especially  if  it  be  on  the  left 
side,  where  an  appendix  abscess  is  not  likely  to  be 
found.  If  the  patient  is  known  to  have  had  a 
pyosalpinx,  especially  if  she  has  given  such 
evidence  of  activity  as  repeated  attack  of  pain,  the 
diagnosis  of  ruptured  pus  tube  is  presumptive. 
Finally,  if  a  previously  palpated  tense  tube  is  now 
felt  flaccid  or  collapsed,  the  diagnosis  may  be 
made  with  much  assurance. 

January  20,  1912. 

Case  I. — C.  B. ;  female ;  married ;  age  24  years ; 
occupation  housewife;  family  and  past  history 
has  no  bearing  on  present  condition.  Has  two 
children,  both  living,  youngest  two  years  old. 
Had  a  miscarriage  last  fall  (about  four  months 
ago).  Has  had  more  or  less  pain  in  right  side 
low  down  for  past  year,  and  much  more  notice- 
able since  miscarriage. 

Between  three  and  four  weeks  ago  pain  became 
much  worse,  and  at  last  menstrual  period  passed 


THE    HOSPITAL   BULLETIN 


207 


lots  of  clotted  blood  and  pus,  and  since  a  discharge 
purulent  in  character  has  continued.  About  this 
time  (two  weeks  ago)  she  had  an  attack  which 
she  though  to  be  influenza,  the  soreness  in  the 
lower  abdomen  and  right  side  was  worse,  and  she 
would  have  sweats  and  chills,  and  chilly  sensa- 
tions being  continued  up  to  the  time  of  perfora- 
tion. 

For  the  past  few  days  the  slightest  jar  or  mov- 
ing about  would  cause  considerable  pain,  and  to- 
ward the  last  she  could  hardly  walk  on  account 
of  pain  which  would  radiate  across  lower  abdo- 
men ;  along  with  this  she  had  a  frequent  desire  to 
urinate.  Yesterday  A.  M.  she  attempted  to  lift 
her  two-year-old  child,  and  when  doing  so  had  a 
severe  sudden  lancinating  pain  low  down  in  her 
abdomen,  and  she  could  not  straighten  up,  the 
pain  soon  became  general  and  the  belly  very  tense, 
vomiting  several  times. 

She  called  her  family  physician,  Dr.  John  Kaul- 
bach  of  Edwall,  who  referred  the  case  to  me.  I 
saw  her  about  30  hours  after  the  rupture  had  oc- 
curred. Her  condition  was  most  critical;  pulse 
120,  temperature  subnormal,  with  a  facies  of  peri- 
tonitis ;  the  belly  was  not  much  distended,  but 
board-like.  I  held  out  very  little  hopes  of  her  re- 
covery to  her  family,  for  I  truly  believed  she  would 
die. 

Vaginal  examination  was  very  unsatisfactory 
on  account  of  extreme  tenderness,  but  I  could 
elicit  a  fixed  uterus  and  a  mass  on  right  side. 
Patient  was  then  transferred  to  the  surgery, 
where  1  made  a  midline  incision  low  down. 
There  was  a  purulent  peritonitis  with  a  quantity 
of  free  pus  in  belly  cavity.  A  general  matting  up 
of  all  the  pelvic  organs,  and  I  broke  into  a  large 
abscess ;  whether  it  was  the  one  which  had  rup- 
tured or  another  I  was  not  certain,  as  the  patient's 
condition  did  not  warrant  me  doing  anything  fur- 
ther, as  she  was  almost  moribund,  so  inserted 
drainage  tubes  into  the  pelvis.  (Might  mention 
here  that  appendix  was  not  involved.) 

Patient  was  given  700  c.c.  normal  salt  infusion 
under  her  breasts  and  put  to  bed  in  a  sitting  pos- 
ture, with  continuous  valine  solution  by  rectum, 
which  was  kept  up  for  four  days.  Patient  made 
a  fair  recovery,  and  was  able  to  leave  the  hospital 
on  the  twenty-seventh  da)'. 

Shortly  after  leaving  the  hospital  the  old  pelvic 
infection  began  to  give  her  more  trouble,  and  she 
returned  February  17,  1912,  and  I  removed  both 
tubes    (double    pyosalinx)    and   appendix.      She 


had  also  been  suffering  with  cramps  (severe  gas 
pains,  as  she  expressed  it), which  would  come  and 
go.  This  was  due  to  the  intestines  being  very 
much  matted,  and  held  together  by  adhesions, 
many  of  which  I  released.  She  was  again  able 
to  leave  the  hospital  on  the  twenty-fifth  day  after 
the  operation,  and  returned  home,  only  to  return 
again  after  about  one  month  for  intestinal  ob- 
struction due  to  adhesion,  and  she  left  the  hos- 
pital for  the  third  time  on  the  twenty-fifth  day 
after  the  operation,  and  has  been  well  and  gaining 
ever  since,  but  for  some  time  she  was  bothered 
with  more  or  less  discomfort  from  adhesions, 
especially  after  eating  heartily.  When  I  saw  her 
a  few  days  ago  this  had  disappeared. 

The  three  following  reports  are  appendix  cases, 
first  due  to  an  ordinary  brass  pin,  second  pin 
worms  and  third  to  an  apple  seed. 

Statistics  showing  foreign  bodies  in  general  as 
predisposing  cause  of  appendicitis  present  consid- 
erable variation.  LTp  until  1906  foreign  bodies 
had  been  found  by  the  late  George  Fowler  in 
one-fifth  of  1  per  cent,  of  2000  cases,  Murphy 
found  foreign  bodies  in  2  per  cent,  of  2000,  and 
Mitchell  7  per  cent,  in  1400  cases. 

At  Cook  County  Hospital  on  post-mortems  of 
3750  subjects  Herneck  found  foreign  bodies  in 
the  appendix  in  but  two  instances.  But  two  cases 
came  under  Dr.  Osier's  observation  in  10  years 
of  pathological  work  in  Montreal.  Sharp-pointed 
metallic  bodies  represent  a  class  by  themselves ; 
they  have  rarely  been  found  in  the  large  surgical 
clinics,  and  their  occurrence  represents  a  curiosity 
and  the  ordinary  domestic  pin  is  the  most  com- 
monly encountered  body  of  this  character,  and  it 
is  estimated  by  Barnes  that  out  of  94  cases  of  true 
foreign  bodies  in  the  appendix,  he  has  tabulated 
the  pin  composing  54  per  cent. 

One  would  naturally  suppose  that  a  pin  would 
lead  to  a  rapid  perforation,  but  this  is  not  usually 
the  case,  according  to  Fowler,  and  he  further 
states  that  it  may  be  found  free  from  deposit,  rusty 
or  corroded.  It  may  form  a  nucleus  for  a  fecal 
concretion,  and  be  either  partially  or  entirely  sur- 
rounded. In  cases  where  the  pin  has  not  been 
entirely  surrounded,  it  is  the  head  that  is  most 
usually  covered  with  soft  or  hard  fecal  matter. 

Case  II. — A.  D. ;  age  two  years ;  boy.  Child 
previous  to  this  illness  was  strong  and  well. 
Mother  noticed  that  when  child  would  lie  on  back 
(making  muscles  of  belly  tense)  that  he  would  act 
as'  though  it  hurt  him ;  also  lifting  and  handling 


208 


THE   HOSPITAL   BULLETIN 


him  would  make  him  cry,  but  this  did  not  excite 
any  anxiety  with  the  mother  until  she  noticed  the 
child  walked  drawn  over  to  the  right  side,  and 
would  lay  with  right  leg  drawn  up. 

Child  was  brought  to  my  office  on  June  8,  with 
history  as  above  stated.  Upon  examining  him 
found  a  distinct  mass  in  right  iliac  region,  very 
tender,  temperature  101  and  pulse  120,  and  I 
made  the  diagnosis  of  an  appendicular  abscess 
which  had  previously  been  made  by  their  family 
physician. 

I  had  the  youngster  transferred  to  St.  Luke's 
Hospital  and  operated.  Upon  opening  the  abdo- 
men over  the  mass  I  broke  into  an  abscess  con- 
taining two  or  three  ounces  of  pus,  which  was 
gently  mopped  out ;  then  I  inserted  my  finger  into 
the  cavity  and  ran  against  something  sharp,  which 
I  thought  to  be  a  needle.  I  did  not  remove  my 
finger,  but  passed  a  forceps  down  and  caught  the 
pin.  The  appendix  came  up  readily  with  the  head 
of  the  pin  still  imbedded  in  it. 

Appendix  removed  and  stump  inverted.  The 
sixteenth  day  after  the  operation  the  youngster 
had  obstruction  symptoms,  which  subsided  with- 
out any  surgical  interference,  and  left  the  hospital 
a  short  while  later. 

Case  III. — School  girl ;  age  nine  years.  Family 
and  past  history  of  no  interest  regarding  present 
trouble.  Present  trouble  had  existed  for  several 
months.  She  would  complain  of  soreness  in 
abdomen  often  and  occasional  severe  pains  that 
would  cause  her  to  go  to  bed  for  part  of  the 
day,  and  usually  her  mother  thought  she  had  a 
temperature,  she  having  been  a  trained  nurse. 

Her  family  physician,  Dr.  J.  F.  Hall,  who  re- 
ferred the  case  to  me,  saw  her  in  this  attack  and 
one  previously  very  much  similar. 

Her  temperature  was  101,  pulse  100.  There 
was  not  very  much  rigidity  over  abdomen,  but 
a  decided  tenderness  over  the  appendix  region 
on  pressure.  We  made  a  diagnosis  of  sub- 
acute appendix  and  advised  removal,  which  was 
done  March  3,  1912.  Upon  removing  the  ap- 
pendix I  was  rather  surprised  not  to  find  a  more 
abnormal  organ,  so  went  in  search  for  other 
trouble,  but  with  no  avail. 

After  operating,  upon  examining  the  appen- 
dix, which  seemed  to  be  moderately  full  and 
soft,  it  did  not  show  any  decided  inflammatory 
condition,  but  was  a  little  clubbed  at  the  end. 
Upon  opening  it  to  my  great  surprise   I   found 


it  absolutely  full  of  pin  worms,  which  were  very 
motile. 

Patient  left  hospital  on  the  eighth  day,  and  Dr. 
Hall  tells  me  he  has  relieved  her  by  proper 
medication  of  thousands  of  these  worms,  and 
the  girl  is  now  perfectly  well. 

Case  IV.  There  is  no  especial  interest,  ex- 
cept being  unusual,  so  will  not  go  into  detail. 

Male,  40  years  old.  History  of  chronic  ap- 
pendicitis for  some  time.  I  removed  sub-acute 
appendix  and  found  an  apple  seed  and  a  small 
fecal  concretion  therein.  Patient  made  an  un- 
eventful recovery. 


DIAGNOSIS    OF    SYPHILIS. 


By  E.   KlLBOURNE  TULLIDGE, 

Senior  Medical  Student. 


Today  it  is  surprising  how  unerringly  the  diag- 
nosis of  syphilis  may  be  made  clinically  without 
the  aid  of  laboratory  tests.  However,  before  the 
introduction  of  the  present  assurative  measures  of 
diagnosis  many  physicians  balked  before  placing 
the  patient  upon  a  long  prescribed  treatment  ex- 
tending over  several  years,  because  of  the  appear- 
ance of  the  initial  sore  alone,  it  being  the  usual 
custom  to  wait  until  the  development  of  the  sec- 
ondary stage  before  administering  anti-luetic 
remedies. 

It  has  certainly  been  a  great  stride  in  the  science 
of  medicine  that  enables  us  today  to  definitely  tell 
a  man  in  half  an  hour  under  favorable  conditions 
that  he  has  the  organisms  of  syphilis  growing 
within  his  body.  Owing  to  the  tenacity  with  which 
nature  guards  her  secrets,  it  has  only  been  within 
the  last  few  years  that  this  refinement  of  diagnosis 
has  been  possible.  It  is  by  no  means  easy  to  dis- 
tinguish the  spirochete  pallida  from  other  organ- 
isms frequently  found  in  the  body;  just  as  the 
Klebs-Loeffler  bacillus  at  times  is  unrecognizable 
from  other  organisms  that  do  not  cause  diph- 
theria. 

There  are  five  scientific  methods  employed  for 
the  diagnosis  of  lues: 

1.  The  discovery  of  the  organism  itself  in  the 
body,  usually  ascertained  by  the  dark  field  illumi- 
nator. 

2.  The  inoculation  of  the  organism  into  the 
lower  animals,  such  as  the  ape,  chimpanzee,  male 
guinea  pig. 

3.  The  Wasserman  test. 


THE   HOSPITAL   BULLETIN 


209 


4.  Growing  the  organism  in  specially  prepared 
culture  media  outside  of  the  body. 

5.  The  skin  test,  Noguchi's  reaction. 

The  first  of  these  methods  may  be  employed  in 
several  ways.  The  dark  field  illuminator  has  been 
exhibited  for  the  past  few  years  at  practically  all 
gatherings  of  medical  men  and  constantly  used  by 
Dr.  Timberlake  in  the  genito-urinary  department. 
This  instrument  places  the  spirochete  in  the  same 
relation  to  the  eye  as  a  grain  of  dust  bears  in  a 
rav  of  sunlight  entering  a  dark  room.  The  organ- 
ism when  seen  in  this  sphere  appears  slender, 
spiral  in  shape,  presenting  from  four  to  twelve 
curves,  pointed  at  each  end;  it  may  appear  in- 
creased in  length,  due  probably  to  the  presence  of 
two  organisms  in  the  act  of  division.  It  is  often 
confused  with  the  spirochete  refringens,  which 
does  not  present  as  uniform  or  as  many  curves, 
and  is  thicker  and  coarser. 

Another  method  occasionally  used  in  differen- 
tiating the  organism  which  may  be  employed  with 
very  little  trouble  and  with  satisfactory  results  is 
the  one  known  as  the  Burri  India  Ink  method.  A 
puncture  is  made  in  the  neighborhood  of  a  chancre 
or  condylomatous  patch,  antiseptic  precautions 
being  used,  and  the  exuding  fluid,  with  as  little 
blood  as  possible,  is  placed  on  a  clean  sterile  slide, 
where  it  is  mixed  with  one  drop  of  corresponding 
size  of  India  ink,  free  from  bacteria.  The  slide  is 
then  brushed  with  a  piece  of  cardboard  or  cigar- 
ette paper,  in  somewhat  the  same  fashion  as  blood 
is  smeared  for  microscopic  examination.  Smear 
dries  very  quickly,  and  may  be  examined  with  an 
oil  emersion  lens.  Organisms  present  will  appear 
white  or  gray  upon  a  blackish  or  slate-colored 
background. 

The  great  drawback  to  this  method  is  the  con- 
fusion occasioned  by  the  presence  of  ordinary 
saprophytic  organisms  contained  in  India  ink  not 
especially  prepared.  However,  upon  studying  the 
specimen,  should  no  other  spirillum  be  present,  it 
is  quite  safe  to  make  the  diagnosis  of  treponema 
pallida. 

The  Wasserman  test  has  been  so  thoroughly 
discussed  by  the  medical  journals  for  the  past 
year  that  it  will  be  hardly  necessary  to  go  into  its 
technique. 

In  inoculating  the  disease  into  lower  animals 
the  male  guinea  pig  is  the  animal  best  to  use,  af- 
fording the  same  results,  with  less  financial  ex- 
penditure, as  the  monkey.  The  material  collected 
from  the  chancre  or  condylomata  of  the  suspect  is 


injected  into  the  animal's  testicle,  which  at  the 
expiration  of  a  week  or  ten  days  will  show  the 
presence  of  the  spirochete  if  examined. 

The  Noguchi  method  is  a  cutaneous  one,  and 
has  been  well  described  in  the  journals  of  the. 
American  Medical  Association,  Vol.  LIX,  No.  14, 
dated  October  5,  191 2,  and  April  20,  191 2,  and 
the  journal  of  Experimental  Medicine,  191 1,  Vol. 
XIV,  557.  The  reaction  is  caused  by  the  injec- 
tion cutaneously  of  Luetin  prepared  from  the  pure 
killed  cultures  of  the  Luetic  spirillum.  This 
causes  an  eruption  varying  from  inflammatory 
nodules  to  pustular  formations  lasting  for  several 
days,  as  a  rule.  The  reaction  may  occur  almost 
immediately,  but  in  some  cases  it  may  commence 
as  late  as  three  or  four  weeks  after  inoculation. 


THE    DEVELOPMENT    OF    ANTISEPTIC 
AND  ASEPTIC  SURGERY. 


By  Emmet  James  Stewart, 
Junior  Medical  Student. 


The  technique  of  wound  treatment  has,  during 
the  last  20  years,  become  more  complicated  by  the 
general  adoption  of  the  antiseptic  system.  Much 
detail  work  has  become  necessary,  the  exact  per- 
formance of  which  is  alone  a  guarantee  of  good 
results.  It  matters  not  how  many  changes  in  the 
practical  application  of  the  method,  which  was 
first  described  by  Sir  Joseph  Lister,  the  principle 
remains  the  same.  In  those  days  the  "antiseptic 
method"  of  Lister  stood  forth  in  relief  against  all 
other  methods.  It  was  based  on  the  germ  theory 
of  infection,  and  consequently  the  only  method 
which  in  a  systematic  way  sought  to  prevent  the 
entrance  of  micro-organisms  into  wounds.  In 
the  course  of  development  it  has  come  about  that 
the  words  antiseptic  and  aseptic  are  used  in  a 
somewhat  different  sense  from  that  which  they 
first  imparted.  Under  aseptic  conditions  we  at- 
tempt to  destroy  all  living  germs  on  hands  of  sur- 
geon, on  the  dressings,  instruments  and  skin  of 
patient  to  be  operated  on  beforehand,  while  under 
the  antiseptic  method  we  attempt,  after  operating 
on  the  patient,  to  destroy  all  micro-organism  by 
washing  out  the  wound  with  various  chemical  an- 
tiseptics and  dressing  wound  with  dressings  which 
have  been  impregnated  with  antiseptics. 

'We  would  today  include  Lister's  antiseptic  meth- 
ods among  our  modern  aseptic  methods.  It  will  be 


2IO 


THE   HOSPITAL   BULLETIN 


of  interest  in  this  connection  to  follow  the  changes 
which  have  taken  place  in  the  latter  until  the  sys- 
tems in  use  today  have  been  developed.  Not  many 
years  after  Lister's  publications  attention  was 
called  to  the  great  inconvenience  of  the  spray  dur- 
ing operations  and  the  application  of  dressings. 
So  great  had  been  the  results  of  wound  treatment 
since  the  Listerian  method  had  been  developed, 
and  so  firm  had  the  belief  in  all  its  details  become, 
that  it  seemed  a  hazardous  proceeding  to  discard 
anything  which  was  deemed  necessary  by  this 
method.  Lister's  method  in  regards  to  antiseptic 
sprays  was  based  on  the  principal  that  infectious 
germs  are  everywhere  suspended  in  the  air,  and 
that  to  render  them  harmless  it  was  necessary  to 
use  a  spray.  But  the  drawbacks  of  the  spray  was 
that  it  drenched  both  patient  and  surgeon,  it  hin- 
dered close  inspection  by  the  surgeon,  and  it  also 
cooled  of!  the  patient  during  serious  operations. 
It  was  now  shown  that  while  the  spray  had  some 
influence  on  the  germs,  it  did  not  destroy  their 
vitality.  About  the  same  time  Trendelenburg, 
and  also  Brims,  had  found  that  the  results  of  anti- 
septic treatment  was  equally  good  whether  the 
spray  was  used  or  not.  So  the  spray  was  dis- 
pensed with,  and  this  marked  one  step  forward  in 
the  development  of  antiseptic  surgery. 

In  1885  the  experimental  method  was  for  the 
first  time  applied  to  determine  the  germicidal  power 
of  various  antiseptics  after  thorough  washing 
with  soap  and  water,  carbolic  acid,  boric  acid  and 
corrosive  sublimate,  and  other  disinfectants  were 
tested  by  Foster  in  these  experiments  with  culture 
media.  He  came  to  the  conclusion  that  corrosive 
sublimate  alone  prevented  the  development  of 
germs. 

Shortly  afterwards  Kiimmel,  and  somewhat 
later  Fuerbringer,  repeated  these  experiments  in 
a  more  satisfactory  manner.  The  question 
whether  or  not  sterilization  of  the  hands  soon 
after  their  contamination  with  septic  material  is 
possible  is  one  of  grave  importance  to  the  obstet- 
rician and  surgeon.  This  question  was  settled  by 
Kiimmel,  who  came  to  the  conclusion  that, 
under  ordinary  circumstances,  cleaning  with 
soap  and  water,  followed  by  an  immersion  and 
rubbing  in  a  6-1000  solution  of  thymol,  a  1-1000 
solution  of  bichloride  or  a  3-100  solution  of  car- 
bolic acid,  was  a  sufficient  guarantee  for  ordinary 
purposes. 

To  Fuerbringer  belongs  the  credit  of  having 
first  called  attention  to  the  fold  and  fissures  of  the 


skin  as  places  which  harbor  impurities,  and  also 
showed  how  difficult  it  was  to  dislodge  the  impuri- 
ties by  mechanical  means,  and,  more  important 
than  this,  he  called  attention  of  surgeons  to  the 
difficulty  of  disinfection  of  the  fingers  in  the  re- 
gions of  the  nails.  He  gave  the  following  method : 
After  cleaning  the  hands  and  nails,  the  nails  being 
always  cut  short,  the  hands  should  be  washed  for 
one  minute  with  soap  and  water,  then  for  one  min- 
ute in  alcohol,  and  after  alcohol  has  evaporated 
put  hand  for  one  minute  in  1-1000  solution  of 
bichloride  or  a  3-100  solution  of  carbolic  acid. 

In  sterilization  of  instruments,  according  to 
plan  of  Lister,  the  instruments  were  put  in  a 
trough  containing  a  carbolic  solution  1-20.  Later 
it  was  recognized  that  mechanical  cleaning  was 
the  most  important  part  of  the  process  of  steriliza- 
tion. Dry  sterilization  of  instruments  was  at  first 
tried  from  a  desire  to  prevent  rusting.  Redard 
discovered  that  steam  under  pressure  at  110°  C. 
absolutely  sterilized  in  from  10  to  15  minutes,  but 
that  sterilization  by  boiling  liquids  could  only  be 
accomplished  at  a  temperature  of  120°  C.  After 
some  experimenting  he  decided  on  a  mixture  of 
40  parts  of  calcic  chloride  and  60  parts  of  water, 
which  boils  at  1 10°  C,  as  a  suitable  medium.  But 
he  did  not  turn  these  results  to  any  further  prac- 
tical use,  believing  in  the  superior  efficiency  of 
steam. 

It  appears  that  Davidsohn,  a  pupil  of  Robert 
Koch,  first  emphasized  the  advantages  of  steriliza- 
tion by  boiling,  but  to  Schiramelbusch  belongs  the 
credit  of  first  having  introduced  the  method  into 
surgical  practice.  After  a  series  of  experiments 
in  von  Bergmann's  Clinic  he  demonstrated  its 
efficiency  and  simplicity.  Instead  of  using  pure 
water,  he  recommends  a  1  per  cent,  solution  of 
plain  washing  soda.  This  serves  two  purposes — 
it  intensifies  the  sterilizing  power  of  the  boiling 
water  by  removing  grease  and  dirt  from  the  sur- 
face of  the  instruments  and  it  prevents  rusting. 

In  regard  to  dressings  by  Lister's  original 
method,  dressings  impregnated  with  chemical  an- 
tiseptics were  used.  But  gradually  chemical  im- 
pregnated dressings  were  discarded,  and  at  pres- 
ent time  they  are  not  used,  except  in  the  case  of 
iodoform  gauze.  We  strive  to  accomplish  the 
same  end  as  Lister  did,  when  he  described  his  car- 
bolized  gauze  to  prevent  wound  infection,  but  we 
now  try  to  do  this  by  aseptical  precaution  before 
and  during  the  surgical  manipulation  and  before 
the  dressings  are  applied.    At  the  present  time  we 


THE   HOSPITAL   BULLETIN 


211 


use  gauze  sterilized  by  means  of  heat,  and  do  not 
irritate  the  wound  by  antisepticallv  impregnated 
gauze.  These  are  some  of  the  advances  which 
have  been  made  in  the  development  of  antiseptic 
and  aseptic  surgery. 


SYMPTOMS  AND  TREATMENT  OF 

SHOCK. 


By  Porter  P.  Vinson, 

Junior  Medical  Student. 


Shock  was  probably  first  recognized  by  Wil- 
liam Clowes  in  1568,  but  it  remained  for  John 
Hunter  to  give  the  first  accurate  description  of  the 
characteristic  symptoms  in  1784.  Clowes  attrib- 
uted this  peculiar  condition  to  the  presence  of 
some  foreign  body,  either  in  the  wound  or  circu- 
lating freely  in  the  blood.  This  opinion,  with 
slight  modifications,  existed  for  quite  a  number 
of  years ;  in  fact,  it  was  one  of  the  foremost  theo- 
ries until  the  latter  part  of  the  nineteenth  century, 
when  Golt  of  Strasburg  made  his  classical  experi- 
ments on  the  frog.  When  a  frog  was  suspended 
with  his  legs  downward  and  then  tapped  on  the 
mesentery  it  was  noticed  that  the  heart  was  sud- 
denly arrested. 

After  a  variable  length  of  time  it  began  to  beat 
again,  but  was  much  paler  than  before,  less  blood 
being  thrown  into  the  aorta.  If  the  frog  was  now 
placed  in  a  horizontal  position,  however,  the  heart 
asumed  a  natural  color,  there  being  a  normal  vol- 
ume of  blood  thrown  into  the  aorta  at  each  con- 
traction. This  arrest  of  the  heart  was  due  to  a 
vaso-motor  paralysis  produced  by  mechanical  irri- 
tation. This  very  wonderful  experiment  of  Goltz 
has  been,  and  is  today,  the  basis  of  the  most 
widely  accepted  theory  of  shock. 

Fisher  accepted  Goltz's  conclusions,  but  he 
added  that  in  this  vaso-motor  paralysis  a  large 
aim 'iint  of  blood  accumulates  in  the  large  abdom- 
inal veins,  and  when  this  paralysis  is  prolonged 
the  patient  dies  from  anemia  of  the  brain  and 
overdistension  of  the  right  side  of  the  heart,  due 
to  this  unequal  distribution  of  the  circulating 
blood. 

Shock,  therefore,  in  its  broadest  meaning,  may 
be  defined  as  "sudden  vital  depression  due  to  an 
injury  or  emotion  which  makes  an  untoward  im- 
pression upon  the  nervous  system."  Surgical 
shock,  with  which  we  are  most  concerned,  is  the 


impairment  or  inhibition  of  the  vaso-motor  sys- 
tem due  to  an  injury. 

The  pathology  of  shock  is  more  or  less  obscure. 
It  has  been  studied  by  Hodge,  who  made  observa- 
tions on  the  microscopical  changes  in  the  nerve 
cells  of  dogs  and  cats  before  and  after  long  elec- 
trical stimulation.  He  found  that  the  outline  of 
the  cells  were  irregular,  the  nucleus  was  smaller, 
irregular  and  stained  darkly ;  also  that  the  cells 
in  the  cerebrum  and  cerebellum  were  decidedly 
smaller,  and  this  was  accompanied  by  an  enlarge- 
ment of  the  pericellular  lymph  space.  He  con- 
cluded that  the  same  changes  occurred  during 
shock  as  during  this  overstimulated  condition. 

The  symptoms  depend  in  a  large  measure  on 
the  severity  of  the  shock,  this  depending,  in  turn, 
on  the  mental  condition  of  the  patient,  and  may 
vary  from  a  temporary  faintness  to  a  profound, 
continued  and  finally  fatal  vital  depression. 

The  symptoms  may  come  on  almost  immedi- 
ately, or  may  be  delayed  for  some  time,  surgical 
shock  usually  coming  on  during  operation. 

Under  the  severer  forms  of  shock  we  recog- 
nize two  types :  First,  the  torpid  type,  or  that  ac- 
companied with  very  much  depression.  This 
torpid  type  shows  the  following  characteristic 
symptoms :  Great  pallor  of  the  skin  and  mucous 
membranes ;  loss  of  facial  expression :  eyes  dull 
and  pupils  dilated  and  reacting  only  very  slowly 
to  light ;  forehead  covered  with  a  cola  sweat ; 
muscular  tonus  markedly  lessened ;  irregular, 
shallow  and  sighing  respiration ;  irregular  and 
weak  heart  action ;  diminished  sensibility ;  sub- 
normal body  temperature,  and  mental  torpor. 

In  rare  cases  we  may  have  nausea  and  vomit- 
ing, and  there  may  be  relaxation  of  the  sphincters, 
causing  the  involuntary  passage  of  urine  and 
feces. 

Next  wre  have  the  nervous  type,  or  that  accom- 
panied with  great  activity  on  the  part  of  the 
patient.  He  becomes  extremely  restless ;  tossing 
about  in  bed  and  crying  out  in  delirium.  The 
pulse  is  thready,  or  possibly  almost  imperceptible  : 
the  respiration  is  irregular  and  shallow. 

The  above-mentioned  symptoms  may  clear  up 
in  from  two  to  twenty-four  hours  spontaneously, 
or  they  may  persist  to  such  a  marked  degree  that 
it  requires  our  best  attention  to  revive  the  patient. 

Those  symptoms  arising  from  purely  emotional 
causes  rarely  require  treatment,  so  our  attention 
will  be  confined  to  the  treatment  of  "surgical 
shock." 


212 


THE   HOSPITAL   BULLETIN 


We  should,  in  all  surgical  procedures,  first  ex- 
amine our  patient  to  ascertain  if  there  is  any  prob- 
ability of  his  not  being  able  to  withstand  the 
operation  without  severe  shock.  If  we  find  upon 
examination  that  he  is  liable  to  suffer  from  shock, 
we  should  be  prepared  for  it,  and  the  family 
should  be  duly  warned. 

In  weak  patients  we  should,  if  possible,  use  a 
local  rather  than  a  general  anesthetic,  for  the 
local  anesthetic,  by  rendering  the  peripheral 
nerves  insensible,  blocks  effectually  the  pathway 
for  any  impulse  to  travel  to  the  vaso-motor  center. 

In  case  you  find  it  necessary  to  use  a  general 
anesthetic,  it  is  well  to  give  your  patient  one- 
twentieth  grain  of  strychnine  and  three  grains 
of  caffeine  citrate  hypodermically  an  hour  before 
the  operation.  Hot  coffee  may  also  be  given  at 
this  time. 

Have  the  room  warm  and  keep  the  patient  well 
covered.  It  is  a  very  good  plan  to  keep  the  oper- 
ating table  warm,  either  by  especially  constructed 
hot-water  pipes  or  by  hot-water  bottles. 

Use  dry  gauze  in  preference  to  moist  dressing. 
Keep  the  extremities  well  covered,  and  in  some 
cases  it  may  be  well  to  bandage  the  lower  iimbs. 

Warm  whisky  mixed  with  water,  as  an  enema, 
during  the  course  of  the  operation,  is  highly  rec- 
ommended. 

The  treatment  as  outlined  above  is  preventive 
rather  than  curative  in  character,  and  when  we 
have  the  active  symptoms  of  shock  manifesting 
themselves  it  becomes  necessary  to  resort  to  more 
active  treatment.  In  this  case  we  should  give  one- 
thirtieth  grain  of  strychnine  and  one-fiftieth  grain 
of  atropin.  Normal  saline  solution  with  the  ad- 
dition of  one  drachm  of  adrenalin  chloride  solu- 
tion (1-1000)  should  be  given  by  hypodermo- 
clysis,  but  care  should  be  taken  not  to  give  it  too 
rapidly  nor  in  too  great  an  amount. 

Tincture  of  digitalis  should  be  given  by  the 
mouth  in  io-drop  doses  whenever  the  patient  is 
able  to  take  it. 

In  the  restless  cases  give  morphine  sulphate, 
one-sixth  grain. 

Finally,  we  may  resort  to  mechanical  methods 
to  revive  our  patient.  These  consist  of  the  prac- 
tice of  artificial  respiration  and  lowering  the  head. 
This  latter  procedure  allows  the  blood  to  reach 
the  anemic  brain,  and  may  be  of  very  great  ser- 
vice. 

Usually  our  patient  will  react  to  shock  without 


any  treatment  whatsoever,  but  we  also  find  cases 
which,  even  with  our  very  best  treatment,  we  are 
unable  to  restore  to  normal. 

It  is  well  for  us  to  bear  in  mind  this  condition 
of  vaso-motor  inhibition  and  paralysis,  and  in  all 
surgical  procedures  be  prepared  to  combat  in  a 
measure  its  untoward  and  sometimes  disastrous 
termination. 


CERTAIN  DISEASES  OF  OLD  EGYPT. 


By  Ejnar  Hansen,  M.D. 


It  may  be  doubted  whether  there  is  truth  in  the 
old  saying  that  "medicine"  is  the  mother  of 
science,  but  at  least  medicine  may  be  called  a 
good  helpmate,  stretching  out  a  helping  hand  in 
many  directions,  and  especially  to  the  archeol- 
ogist. 

Normal  prehistoric  skeletons  have  been  carefully 
examined  by  medical  authorities  many  times,  and 
the  science  of  anthropology  is  built  up  upon  recent 
examinations  and  comparisons  of  the  different 
discoveries.  Only  in  late  years  and  by  help  of  an 
extremely  well-developed  microscopical  and  bac- 
teriological technique  has  it  been  possible  to  trans- 
fer the  studies  to  the  pathological  field  and  to 
take  the  first  step  in  the  study  and  description  of 
the  diseases  of  the  old  and  prehistoric  peoples. 

Dr.  J.  W.  S.  Johnson  of  Copenhagen  writes  a 
very  interesting  account  in  "Ugeskrift  for 
Larger"  about  different  diseases  found  among  the 
old  Egyptians.  Evidence  of  caries  of  bones  in 
mummies  was  found  several  years  ago,  and  the 
excavations  of  the  burial  place  at  Dakka  in  1909 
gave  us  much  material  for  study  and  further  in- 
creased our  knowledge  of  certain  bone  diseases. 
Four  out  of  ten  excavated  skeletons  showed  a 
diseased  condition  of  the  spine,  and  these  four 
skeletons  came  from  only  two  graves.  The  one 
grave  contained  skeletons  of  a  man  and  a  woman, 
both  with  carious  destruction  of  small  vertebrae. 
The  other  tomb  contained  skeletons  of  two  men 
and  a  nine-year-old  boy.  One  man  had  a  kypho- 
sis caused  by  the  destruction  of  two  vertebrae. 
The  boy  had  five  vertebrae  partly  destroyed  and 
grown  together  in  a  solid  mass.  The  microscop- 
ical examination  of  these  cases  has  not  vet  been 


THE   HOSPITAL   BULLETIN 


213 


published,  but  it  seems  impossible  to  eliminate 
tuberculosis  as  the  cause. 

There  are  here  two  possibilities.  This  is  either 
the  ravage  of  tuberculosis  in  a  single  family  or  a 
collection  in  one  place  of  patients  with  this  par- 
ticular disease.  Why  the  latter  should  be  the 
case  we  do  not  know;  therefore  the  first  is  the 
more  probable. 

Dr.  Marc  Armand  Ruffer,  president  of  the 
Egyptian  Department  of  Health,  has  for  a  long 
time  "undertaken  microscopical  examinations  of 
normal  and  pathological  tissues  in  mummies.  He 
describes  bis  methods  in  Cairo  Scientific  Journal 
I  Vol.  IV,  No.  40),  and  according  to  his  report  he 
found  the  following  diseases  among  the  old 
Egyptians:  Arteriotherom,  anthracosis  pulmo- 
num,  croupous  pneumonia,  cirrhosis  of  liver,  ab- 
scesses of  kidneys  and  bladder,  calcified  Bilharzia 
eggs,  and  several  times  he  has  been  able  to  prove 
the  presence  of  bacteria  in  liver  and  lung  tissues. 
Jn  one  case  the  liver  and  lungs  were  so  filled  with 
a  micro-organism  so  similar  to  plague  bacilli  that 
the  proof  of  plague  lacked  only  a  few  abscesses. 
In  another  case  he  found  abscesses  with  colon 
bacilli.  He  has  not  yet  been  able  to  prove  the 
presence  of  tubercular  bacilli. 

Gibbosities  seems  to  be  rather  common,  and 
were  also  found  in  the  ape  mummies.  YVe  know 
now  that  many  apes  die  of  tuberculosis. 

So  long  as  the  presence  of  tuberculosis  has  not 
been  positively  proven,  we  can  only  guess,  as  has 
been  done  in  many  hip  diseases  analogous  with 
coxitis  tuberculosa. 

Dr.  Ruffer  found  in  one  mummy  spondylitis, 
arthritis  cubiti  with  fistula,  and  an  infection  in 
the  ilio-sacral  joint. 

Science  is  approaching  nearer  and  nearer  to  the 
correct  diagnosis  of  these  cases. 

Dr.  G.  E.  Smith  and  M.  A.  Ruffer  have  exam- 
ined a  humpback  mummy  from  the  twenty-first 
dynasty  (about  1000  years  B.  C.)  This  was 
found  in  a  tomb  at  Deir  el  Bahari.  The  de- 
struction was  in  the  fourth  last  dorsal  and 
first  lumbar  vertebrae :  there  was  plenty  of  new 
bone  tissue;  the  spinal  column  was  very  much 
bent,  and  the  point  of  the  angle  was  made  of  the 
eighth  and  ninth  dorsal  vertebrae.  In  the  right 
side  was  found  a  broad  flat  intumescence  spread- 
ing downwards  and  outwards  into  the  right  fossa 
ilica.  There  were  no  fistulae  in  the  skin ;  the  in- 
tumescence was  at  the  place  of  the  psoas  muscle. 


A  more  detailed  account  of  this  case  by  the 
above-named  doctors  and  an  introduction  by  Dr. 
K.  Sudhoff  can  be  found  in  "Znr  historischen 
Biologic  der Krankheitserreger"  (Vol.  III). 


In  writing  to  Mrs.  Hemmeter  concerning  the 
illness  of  Professor  Hemmeter,  Carl  Anton 
Ewald,  professor  of  medicine  at  the  University 
of  Berlin,  says  in  German : 

"Undoubtedly  he  has  worked  too  much  again, 
but  I  am  glad  to  know  that  everything  is  being 
done  to  save  this  active  and  brilliant  mind  to  us 
and  to  American  medicine.  But  absolute  rest  for 
a  mind  that  is  so  much  in  love  with  work  is  a  very 
difficult  matter  to  enforce,  and  you  will  have  to 
have  patience  with  him.  I  am  very  glad  and 
comforted  to  know  from  the  latest  reports  that 
he  is  improving.  I  congratulate  him  and  you  on 
his  election  as  honorary  member  of  the  German 
Phvsiolosfical  Society." 


Among  the  University  alumni  practicing  in 
Kentucky  are : 

Lexington — Abram  L.  Blanding,  class  of  1881. 

Louisville — Henry  R.  Carter,  class  of  1879, 
Surgeon  U.  S.  P.  H.  and  M.  H.  S.,  Marine  Hos- 
pital. 

Richmond — C.  J.  Bales,  class  of  1878. 

Russellville — John  K.  W.  Piper,  class  of  1893. 


Among  the  University  alumni  practicing  in 
Louisiana  are: 

Coushatta — Wm.  A.  Boylston,  class  of  1871. 

Haughton — John  E.  Rooks,  class  of  1905. 

Xew  Orleans — YYm.  Henry  Block,  class  of 
1895.  832  Canal  street;  Wm.  Buford  Clark,  class 
of   1882,  1301  Magazine  street. 

Shreveport — Emmet  A.  Welsh,  class  of  1887, 
Lew  Building:. 


Among  the  University  alumni  practicing  in 
Iowa  are  : 

Carlisle — Wm.  Edgar  Sperow,  class  of  1894. 

Des  Moines — David  Wilson  Smouse,  class  of 
1876.  Knights  of  Pythias  Building. 

Sabula — Franklin  D.  Ayers,  class  of  1892. 

Shenandoah — Lynn  J.  Putnam,  class  of  1909. 

Waterloo — Ernest  J.  Waddey,  class  of  1891, 
Lafayette  Block. 


214 


THE    HOSPITAL    BULLETIN 


THE   HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

PUBLISHED  BY 

THE  HOSPITAL  BULLETIN   COMPANY 

COS  Professional  Building 

Baltimore,  IV \>. 


Subscription  price,     .     .     .     $1.00  per  annum  in  advance 

Reprints   furnished   at  cost.     Advertising   rates 

submitted  upon  request 


Nathan  Winslow,  M.D.,  Editor 


Baltimore,  January  15,  1913. 


THOMAS   FELL,  A.M.,  Ph.D.,  LL.D.,  THE 
NEW  PROVOST. 


At  the  meeting  of  the  Board  of  Regents,  held 
Tuesday,  January  9,  1913,  upon  the  recommenda- 
tion of  the  committee  appointed  for  the  purpose 
of  selecting  a  Provost  in  place  of  the  late  Bernard 
Carter,  Dr.  Thomas  Fell,  President  of  St.  John's 
College,  Department  of  Arts  and  Sciences,  was 
chosen  for  the  position.  Undoubtedly  the  selec- 
tion will  meet  with  the  approval  of  even- 
alumnus,  as  Provost  Fell  is  an  educator  of  wide 
experience  and  in  touch  with  modern  educational 
methods.  The  University  is  to  be  congratulated 
upon  its  choice,  and  is  indeed  fortunate  to  have 
such  a  man  at  its  head.  For  the  first  time  in  the 
more  than  one  hundred  years  of  its  existence  the 
University  of  Maryland  has  a  real  head ;  as  a 
consequence  of  which  we  can  confidently  look 
forward  to  the  institution  taking  on  new  life  and 
expanding  into  new  fields  of  usefulness.  This 
appointment  marks  an  epoch  in  our  history,  a 
passing  of  the  old  order  of  events  and  the  celebra- 
tion of  a  new  birth.  Our  dreams  for  a  better  and 
greater  University  of  Maryland,  we  feel  assured, 
will  now  come  true.  During  the  past  decade 
there  has  been  a  gradual  change  of  view  by  those 
in  charge  of  the  destinies  of  our  Alma  Mater. 
Some  were  too  discouraged  to  perceive  it,  but 
others  had  stout  hearts,  and  sincerely  believed 
that  the  Board  of  Regents  were  alive  to  the  neces- 
sities for  change  in  the  method  of  conduct  of  the 
affairs  of  the  institution.  Their  faith  has  been 
justified,  and  undoubtedly  will  be  further  re- 
warded by   still  greater   changes  in  the  organic 


reorganization  of  the  institution  in  the  near  fu- 
ture. Remember,  in  the  meantime,  however,  that 
a  transition  is  on,  and  that  the  authorities  need 
your  help,  sympathy  and  encouragement.  Do  not 
expect  of  Provost  Fell  too  much  in  the  beginning. 
Give  him  time  to  become  thoroughly  acquainted 
with  the  affairs  of  the  institution,  and  The  Bul- 
letin predicts  that  he  will  evolve  a  new  institu- 
tion upon  the  framework  of  the  old. 

For  the  present  it  is  planned  that  Dr.  Fell  will 
open  an  office  at  the  University  and  give  Satur- 
days and  at  least  two  afternoons  a  week  to  the 
institution  as  an  entirety.  It  is  also  proposed  to 
have  an  office  force  to  assist  him. 

Dr.  Fell  is  regarded  as  one  of  the  leading  edu- 
cators of  this  part  of  the  country.  His  ability  as 
an  administrator  has  been  tried  as  the  president 
of  St.  John's  College.  In  the  opinion  of  all  who 
have  watched  the  growth  of  that  institution  under 
his  leadership,  he  has  been  remarkably  successful. 

'When  he  assumed  charge  of  the  old  institu- 
tion, which  was  founded  in  1696  and  thus  ranks 
as  one  of  the  oldest  colleges  in  America,  a  great 
deal  of  its  prestige  had  been  lost,  and  there  was 
clanger  that  it  would  suffer  the  same  fate  as  a 
number  of  other  small  colleges  had. 

With  signal  ability  Dr.  Fell  set  to  work  to 
restore  St.  John's  to  its  former  position.  When 
he  took  charge  there  was  a  long-standing  mort- 
gage of  $30,000  hanging  over  the  school. 
Through  his  efforts  that  has  been  entirely  wiped 
out.  The  final  accomplishment  of  his  adminis- 
tration was  the  merging  of  St.  John's  with  the 
University  of  Maryland. 

Dr.  Fell  was  born  in  Liverpool,  England,  July 
15,  1851.  His  father  was  a  surgeon  in  the  Eng- 
lish Army,  and  was  killed  in  the  Crimean  War. 
Dr.  Fell  was  educated  at  the  Royal  Institution 
School  of  Liverpool  and  at  King's  College,  Lon- 
don. He  later  entered  the  University  of  London, 
and  then  studied  for  a  year  at  the  University  of 
Munich.  He  came  to  America  in  1882,  and  in 
1884  was  elected  professor  of  ancient  languages 
at  New  Windsor  College,  New  Windsor,  Md. 
In  1886  he  was  elected  to  the  presidency  of  St. 
John's  College,  being  the  twelfth  president  of  its 
now  123  vears  of  existence.  St.  John's  College 
has  conferred  upon  him  the  honorary  degree  of 
doctor  of  philosophy,  and  the,  University  of  the 
South  that  of  doctor  of  civil  law.  while  Hampton- 
Sidney  College  has  honored  him  with  the  degree 


THE   HOSPITAL   BULLETIN  215 

of  doctor  of  laws.     llis  Standing  as  an  educator  feci  that  he  is  entitled  to  eat  a  bountiful  Christ- 
is  recognized  everywhere.     Dr.  Fell  is  a  member  mas    dinner    without    having'    in    some    measure 
of   the    American    Philological    Association,    the  helped  to  bring  good  cheer  to  others  less  fortu- 
Nalional  Educational  Association,  the  Phi  Sigma  natc  than  himself.    We  give  presents  to  our  fami- 
Kappa  Fraternity,  the  I  "niversity  Club  of   Haiti-  lies  and  friends,  and  receive  tokens  of  love  and 
more,   and    the   Cliosophic    Society   of   Princeton  esteem  from  them  in  return.     The  same  custom 
University.  might  be  appropriately  established  between  insti- 
The   formal  induction  into  office  of  Dr.  Fell  tutions  of  learning  and  their  children  and  friends, 
should  be  made  a  memorable  occasion.    No  stone  The  college  gives  far  more  to  its  pupil  than  it 
should  be  left  unturned  to  make  it  as  impressive  receives  in   financial   returns.      The   young  man 
as    possible.     The   event,   in   our   opinion,   is   of  receives  instruction,  training,  inspiration  and  op- 
greater    importance   than   our    recent   centennial  portunities  that  are  of  the  greatest  use  to  him. 
celebration,  as  it  marks  a  new  departure  in  the  For  these,  mayhap,  he  pays  a  moderate  charge 
career  of  the  University  of  Maryland,  and  should,  and  then  calls  the  account  square.     But  the  ac- 
therefore,  be  celebrated  befittingly.  count  is  not  settled ;  institutions,  like  individuals, 
We  have  no  patience  with  those  who  cry,  "We  require  financial  assistance,  and  to  whom  can  they 
have  permitted  our  opportunity  to  pass."    Oppor-  turn  for  help,  with  the  same  expectation  of  re- 
tunity  knocks  more  than  once  at  every  gate ;  it  is  ceiving  it,  as  to  their  own  alumni,  who  have  been 
knocking  at  ours  now.  nurtured  and  strengthened  and  sent  on  their  way 
"They  do  me  wrong  who  say  I  come  no  more  t0   batt,e  with  and  overcome  the   obstacles  that 
When  once  I  knock  and  fail  to  find  you  in  ;  confront  them  ? 
For  every  day  I  stand  outside  your  door,  The  University  of  Maryland  has  given  much 
And  bid  you  wake  and  rise  to  fight  and  win.  and  has  received  but  little.    There  is  urgent  need 
Wail  not  for  precious  chances  passed  away ;  for  at  least  five  endowed  chairs,  but  at  present  we 
Weep  not  for  golden  ages  on  the  wane ;  are  endeavoring  to  raise  funds  for  but  one  de- 
Everv  night  I  burn  the  records  of  the  day ;  partment,  that  of  pathology.     We  need  $100,000 
At  sunrise  every  soul  is  born  again.  for  this  purpose,  and  have  about  $20,000  in  hand. 
Laugh  like  a  boy  at  splendors  that  have  sped,  Friends    and    fellow-alumni,   the   need    is    great. 
To  vanished  joys  be  blind  and  deaf  and  dumb  ;  Will  you  not  help  us,  in  such  measure  as  you  can, 
My  judgments  seal  the  dead  past  with  its  dead,  to  raise  this  fund  ? 

But  never  mind  a  moment  yet  to  come.  contribution    by   classes. 

Though  deep  in  mire,  wring  not  your  hands  and  „  „                                                                    „. 

&  '  &         J  jg43 $5000 

weep ;  ~l 

T1      ,  ,       „     ,  ,T         ,,  „  1864 2000 

1  lend  my  arm  to  all  who  sav   i  can ! 

1868 1000 

This  is  an  opportunity ;  let  us  help  Provost  Fell      1871 35  00 

to  grasp  it.  1872 81  84 

■  1873 49183 

THE  HOLIDAYS— GIVING  AND  RECEIV-     1874 : 5  00 

ING.  1875 5  00 

1876 115  00 

The  college  exercises  closed  on  December  21,      1877 10  00 

and  were  resumed  on  January  3.    We  hope  that      1880 5  00 

all  students  and  teachers  alike  have  enjoyed  the      1881 252  00 

respite  from  classes  and  have  returned  to  their      1882 310  00 

work  refreshed  and  invigorated.    The  Yuletide  is,      1883 40  00 

for  most  of  us,  a  time  of  good  cheer ;  a  time  of      1884 40  00 

family  gatherings  and  of  social  festivities.     It  is      1885 235  00 

also  a  time  for  sharing  with  others,  of  giving  and      1886 100  00 

receiving.     However  pleasant  it  may   be  to  re-      1888 SO  00 

ceive  gifts,  wre  believe  "it  is  more  blessed  to  give      1889 100  00 

than  to  receive."    The  writer  personally  does  not      1890 175  °° 


2l6 


THE    HOSPITAL   BULLETIN 


1892 150  00 

1893 40  00 

1894 135  00 

"^95-  •  r J55  00 

1896 52  00 

1897 80  00 

1898 115  00 

1899 55  oo 

1900 215  00 

1901 270  00 

1902 330  00 

1903 34o  00 

1904 135  00 

1905 220  00 

1906 175  00 

1907 no  00 

1908 20  00 

1909 1 5  00 

1910 50  00 

7911  Terra  Mariae 3  5° 

1912  Club  Latino  Americano 25  00 

Total  subscriptions  to  Jan.  1,  1913.  .$10,372  17 

NEW  SUBSCRIPTIONS  IN.  DECEMBER,    I912. 

Randolph  Winslow,  1873 $50  oo 


ITEMS 

It  is  with  much  pleasure  that  we  acknowledge 
receipt  of  a  paper  from  Dr.  Najib  Kenawy,  class 
of  1905,  of  Alexandria,  Egypt,  upon  the  sub- 
ject of  gastroenteritis.  He  says  that  at  this  time 
the  physicians  of  Egypt  are  having  much  discus- 
sion as  to  the  proper  method  of  treatment,  and 
tells  in  his  paper  about  treatment  by  hypodermic 
injections  of  sea  water.  This  will  be  published 
in  The  Bulletin  within  the  next  few  months. 


Among   the   University   alumni    practicing   in 
Arizona  is : 

John  Holt  Lacy,  class  of  1879,  at  Miami. 


The  following  alumni  were  among  those  who 
successfully  passed  the  examinations  of  the 
State  Board  of  Medical  Examiners  in  Decem- 
ber, and  to  whom  licenses  to  practice  have  been 
issued :  Drs.  Bernard  Mark  Berngartt,  James 
Archie  Duggan,  William  Edwin  Gallion,  Jr., 
Moses  Randolph  Kahn,  John  Charles  Norton, 
John  Andrew  Skladowskv,  all  of  the  class  of 
1912,  and  Dr.  Isidore  Isaac  Hirschman,  class  of 
1911. 


We  are  glad  to  announce  that  Dr.  William 
Tarun,  class  of  1900,  who  has  been  away  for 
some  time  owing  to  ill-health,  has  sufficiently  re- 
covered to  return  to  Baltimore  and  resume  his 
practice. 


Among  the  University  alumni  practicing  in 
Alabama  are : 

Birmingham  —  Joseph  Thomas  Coulbourn, 
class  of  1886,  Woodward  Building;  William 
Groce  Harrison,  class  of  1892,  Empire  Building; 
Howell  Towles  Heflin,  class  of  1893,  109^2  N. 
20th  street;  Devotie  Dennis  Jones,  class  oi  1872, 
5602  Second  avenue,  South;  E.  Laurence  Scott, 
class  of  1906,  Woodward  Building;  Lewis  Green 
Woodson,  class  of  1887,  Woodward  Building. 

Childersburg — Thomas  Jefferson  Powell,  class 
of  1866. 

Dadeville — Eugene  Walker  Hart,  class  of 
1891. 

Equality — James  Columbus  Cousins,  class  of 
1891. 

Roanoke — William  Gibson  Floyd,  class  of  1878. 


Dr.  William  Fulford  Sappington,  class  of 
1001,  of  Webster's  Mills,  Pa.,  visited  the  hos- 
pital December  13,  bringing  a  patient  for  opera- 
tion. Dr.  Sappington  has  had  20  cases  of  ty- 
phoid fever  recently  under  his  care. 


Dr.  Isadore  Isaac  Hirschman,  class  of  191 1, 
who  recently  passed  the  State  board  examiners, 
is  connected  with  the  State  Sanatorium  at  Sa- 
billasville. 


As  we  go  to  press  we  are  informed  that  the 
council  on  education  of  the  American  Medical 
Association  has  rated  the  University  of  Mary- 
land as  a  Class  A  school. 


Dr.  Nathan  R.  Gorter,  class  of  1879,  of  1  W. 
Biddle  street,  has  been  appointed  Health  Com- 
missioner of  Baltimore,  succeeding  the  late  Dr. 
James  Bosley.  Dr.  Gorter  was  born  in  Baltimore 
county,  Maryland,  April  25,  i860,  son  of  Gosse 
Onno  and  Mary  Ann  Polk  Gorter.  His  father 
was  descended  from  early  Dutch  settlers,  and  his 
mother's  family  was  of  Scotch-Irish  origin.  He 
was  educated  in  the  Anne  Arundel  County  Acad- 
emy 'and  the  University  of  Maryland.  Since 
graduation  he  has  practiced  in  Baltimore,  and  has 
won  an  enviable  reputation  both  as  practitioner 


THE   HOSPITAL   BULLETIN 


>i7 


and  a  teacher.  He  filled  in  1884  the  chair  of  sur- 
gery in  the  Baltimore  Polyclinic.  From  1898  to 
1904  he  was  surgeon  to  the  Cambridge  Hospital, 
and  since  1894  he  has  been  consultant  in  surgery 
to  that  hospital,  lie  is  a  member  of  the  Medical 
and  Chirurgical  Faculty  and  the  American  Med- 
ical Association.  He  is  a  member  of  St.  Paul's 
Protestant  Episcopal  Church,  and  belongs  to  the 
Maryland  and  Baltimore  Country  Clubs,  the 
Baltimore  Athletic  Club  and  the  Bachelor's  Cotil- 
lion Club.  He  married  May  4,  1898,  Miss  Mary 
Gordon  Norris. 

In  the  Health  Department  Dr.  William  Royal 
Stokes,  class  of  1891,  has  been  bacteriologist  for 
many  years,  and  will  retain  that  position. 

After  his  appointment  Dr.  Gorter  said : 

"I  was  much  pleased  when  the  late  Dr.  Bosley 
was  reappointed  by  the  Mayor,  and  deeply  regret 
that  he  was  not  spared  to  fill  out  his  allotted  time. 

"When  the  present  vacancy  occurred  many  of 
my  friends  were  kind  enough  to  express  their 
wish  that  I  should  be  appointed  Health  Commis- 
sioner, and  when  Mr.  Preston  tendered  me  the 
position  I  felt  it  was  a  public  duty  which  I  should 
accept. 

"The  Mayor  is  deeply  interested  in  the  devel- 
opment of  the  Health  Department,  fully  realizing 
that  the  health  of  the  citizens  of  Baltimore  is  the 
fundamental  factor  in  the  development  of  our 
city.  His  wish  is  to  have  one  of  the  most  up-to- 
date  departments  of  health  in  the  country,  and  I 
know  we  will  have  his  most  hearty  co-operation 
in  the  continual  development  of  our  department. 

"I  fully  realize  the  responsibility  of  directing 
the  department,  which  has  as  its  duty  the  safe- 
guarding of  the  health  of  the  citizens  of  Balti- 
more, and  my  first  duty  will  be  to  thoroughly  fa- 
miliarize myself  with  the  working  of  the  integral 
parts  of  the  Health  Department. 

"I  ask  and  confidently  expect  the  hearty  co- 
operation of  the  medical  profession  and  of  the 
citizens  of  Baltimore  in  the  continued  upbuilding 
of  this  very  important  department  of  the  city 
government." 


Tbe  engagement  is  announced  of  Miss  Lucy 
Perry,  daughter  of  Mrs.  S.  M.  Perry,  of  Atlanta. 
Ga.,  to  Dr.  Emmett  O'Brien  Taylor,  class  of 
191 1,  of  Greelyville.  S.  C.  The  marriage  will 
take  place  in  the  early  spring.  Dr.  Taylor  wrote 
us  recently  and  said  that  he  enjoys  reading  the 
Bulletin.     He  adds  the  following,  which  may 


comfort  some  of  his  classmates  in  the  same  boat: 
"I  am  not  getting  rich  down  here,  but  am  getting 
three  square  meals  a  day  and  a  goose-hair  bed  to 
sleep  on  at  nights.  That's  not  bad,  after  all.  You 
bet  I  get  my  sbare  of  the  spoils.  How  could  a 
U.  of  M.  man  do  otherwise?" 


Dr.  1  lenry  R.  Carter,  class  of  1879,  senior  sur- 
geon of  the  United  States  Public  Health  Service, 
has  been  placed  in  charge  of  the  United  States 
Marine  Hospital  in  Baltimore.  Dr.  Carter  is  a 
native  of  Virginia,  and  attended  the  University 
of  Virginia  three  years,  and  then  entered  the  Uni- 
versity of  Maryland,  graduating  in  1879.  He 
entered  the  United  States  Marine  Hospital  Serv- 
ice the  same  year.  He  was  the  first  officer  of  the 
service  to  receive  a  commission  to  go  to  Panama 
after  the  United  States  took  control  of  the  hos- 
pital. He  took  a  foremost  part  in  the  work  of 
making  the  canal  region  a  fit  habitation  for  Amer- 
ican men.  His  work  in  the  yellow  fever  epi- 
demics of  1893,  1897,  1898  and  1899  is  known 
everywhere,  and  the  first  instance  in  the  far  South 
where  an  epidemic  of  yellow  fever  was  suppressed 
was  when  he  was  working  in  Southern  Missis- 
sippi in  1898.  For  four  and  a  half  years  he  was 
director  of  hospitals  in  the  Canal  Zone,  and  re- 
cently located  at  the  Government  Hospital  in 
Louisville.  Ky.,  from  where  he  came  to  Baltimore 
to  take  the  place  left  vacant  by  Dr.  W.  P.  Mcin- 
tosh, who  has  been  transferred  to  Louisville,  Ky. 
Dr.  Carter  has  been  stationed  in  Baltimore  twice 
before.  The  University  is  glad  to  welcome  him 
to  Baltimore,  and  considers  that  his  work  will 
always  be  linked  with  Finlay's  in  connection  with 
pioneer  work  in  yellow  fever. 


UNDERGRADUATE  NOTES 


Under  the  Supcri'ision  of  E.  Kilbourn  Tullidge. 


At  a  meeting  of  the  senior  class,  the  remaining 
offices  were  filled  as  follows :  Honor  committee, 
T.  Ruffin  Pratt,  chairman;  Manly  Coke  Smith, 
Yertie  Edward  Edwards,  Frederick  R.  Devine, 
William  Tillman  Martin ;  sergeant-at-arms,  Ed- 
gar E.  Travers ;  poet.  Frederick  Leonard  Mc- 
Daniel ;  associate  editor  of  Old  Maryland, 
Charles  Reid  Edwards. 


Mr.  John  Thomas  Beavers  of  the  senior  class, 
who  was  operated  on  in  the  Uniyersity  Hospital 


2l8 


THE   HOSPITAL   BULLETIN 


earl)'  in  January  for  chronic  appendicitis,  is  now 
convalescing:  and  will  soon  be  out  again. 


Mr.  Franklin  Dashiell  Murphy  of  the  senior 
class  was  operated  on  for  imperfect  nasal  septu 
late  in  December.  Although  the  operation  proved 
successful,  he  has  been  suffering  intensely  from 
shock. 


Among  the  new  men  entering  the  hospital  as 
clinical  assistants  is  Gerard  Lebret,  who,  it  will 
be  remmbered,  was  confined  to  bed  in  the  hos- 
pital during  the  greater  part  of  his  last  year's 
session. 


Everyone  is  anxiously  awaiting  the  publication 
of  the  1913  Terra  Mariae,  which  is  under  the 
direction  of  Editor-in-chief  Earle  Griffith  Breed- 
ing of  the  senior  class.  Mr.  Breeding  informs 
us  that  the  book  will  be,  both  in  size  and  contents, 
larger  and  better  than  in  former  years,  and  con- 
sequently a  higher  price  will  have  to  be  asked. 
It  will  be  ready  for  publication  about  the  first 
of  May.  Copies  will  be  reserved  for  those  mak- 
ing a  deposit  of  $1  with  Mr.  Breeding. 


At  a  meeting  of  the  clinical  assistants,  the 
executive  committee  appointed  the  following 
men  to  arrange  for  the  annual  house  dance  to  be 
held  on  Friday  evening,  January  17,  1913,  at 
Albaugh's  Parlors  :  Messrs.  Earle  Griffith  Breed- 
ing, Harry  C.  Raysor,  Robert  Raymond  Sellers, 
H.  W.  Butler  and  Norbert  Charles  Nitsch.  In- 
vitations have  been  extended  to  the  internes  and 
members  of  the  senior  faculty. 


Mr.  George  Ward  Disbrow,  class  of  1913,  was 
operated  on  in  the  hospital  on  January  8  and  is 
now  convalescent. 


Manager  H.  H.  Warner  of  the  basketball 
team  states  that  though  the  squad  has  been  un- 
der the  direction  of  Professor  Pennington  of  the 
Central  Y.  M.  C.  A.,  it  has  exhibited  poor  show- 
ing, which  Mr.  Warner  states  is  due  to  the  lack 
of  support  and  co-operation  on  the  part  of  the 
faculty  of  the  various  departments  of  the  Uni- 
versity. The  members  of  the  team  complain  that 
they  are  unable  to  obtain  leave  of  absence  on 
days  of  practice,  and  are  thus  handicapped. 
"Practice  makes  perfect"  is  an  old  maxim,  and 


if  we  expect  to  turn  out  a  team  worthy  to  repre- 
sent the  University  we  must  give  them  an  oppor- 
tunity to  practice.  The  games  played  and  the 
scores  are  as  follows : 

Seton  Hall  College — At  South  Orange,  N.  J., 
42-21. 

Columbia  University — At   New   York,   41-16. 

City  College  of  New  York — 20-18. 

Georgetown  University — At  Washington,  D. 
C,  20-18. 

Loyola  College — At  home,  21-16. 

In  the  Georgetown  game,  Peters  (law,  1915) 
and  Peppers  (law,  1915)  showed  excellent  speed 
and  clever  passing.  It  will  be  noted,  however, 
that  the  University  lost  in  each  game,  although 
they  were  much  improved  in  the  later  games. 

The  remaining  games  will  be  played  with 
Swarthmore  at  Swarthmore  on  January  10;  Mt. 
St.  Joseph's,  at  Baltimore  Y.  M.  C.  A.,  January 
15;  Catholic  University,  at  home,  and  George- 
town University,  at  home. 

The  line-up  is  as  follows : 

Forivards — Peters  (law,  1915),  Gavis  (law, 
1915),  Timanus  (medical,  1914). 

Center — Hughes  (dental,  1915). 

Defense — Thomas  (medical,  1916),  Peppers 
(law,  1915). 

Substitutes — Gardner  (pharmacy,  1913),  Zim- 
merman (law,  1915). 


MARRIAGES 

Mr.  and  Mrs.  Albert  G.  Tews  announce  the 
marriage  of  their  daughter,  Miss  Gertrude  Hed- 
wig  Tews,  University  Hospital  Training  School 
for  Nurses,  class  of  1909,  to  Mr.  Lewis  S.  Cole 
of  Jessups,  Md.  The  couple  will  be  at  home  after 
February  1  at  Jessups.  Mrs.  Cole  is  a  native  of 
Germany. 


Dr.  Frank  Sidle  Lynn,  class  of  1907,  and  Miss 
Clyde  Clayton  Dawson,  University  Hospital 
Training  School  for  Nurses,  class  of  1908,  were 
married  in  Norfolk,  Va.,  on  Saturday,  December 
14,  1 912.  The  ceremony  was  performed  at  the 
Hotel  Monticello  by  Rev.  William  Cox,  a  cousin 
of  the  bride.  Mrs.  Lynn  is  a  native  of  Griston, 
N.  C. 


Dr.  William  A.  Ellingwood,  class  of  1908,  of 
Winterport,   Maine,  was   married  on  November 


TI1IC    HOSPITAL    BULLETIN 


219 


28,  191 2,  to  Miss  Ruth  Anne  Kellam  of  Onan- 
cock,  Ya.  The  ceremony  was  performed  by  Rev. 
L.  M .  Betty  at  the  home  of  the  bride's  sister,  Mrs. 
I.  C.  W.  Leatherbury,  and  immediately  after- 
wards the  couple  left  for  their  home  in  Winter- 
pi  irt.  Mrs.  EMingwood  is  a  graduate  of  the 
Woman's  College,  Lynchburg.  Ya.  Dr.  Elling- 
wood  was  for  a  time  after  his  graduation  resident 
physician  of  the  Presbyterian  Eye,  Ear  and 
Throat  Hospital  of  Baltimore. 


Miss  Mary  Dorsey  Mitchell,  daughter  of  Dr. 
Alexander  Mitchell,  class  of  1877,  of  Glencoe, 
Md.,  was  married  on  Saturday,  January  11,  to 
Mr.  Warren  Keach  Magruder  of  Baltimore. 
Mrs.  Alagruder  was  operated  on  at  the  Balti- 
more Eye,  Ear  and  Throat  Hospital  on  Friday 
night,  and  left  the  Hospital  to  be-  married  in 
Emmanuel  Church,  returning  there  immediately 
after  the  ceremony,  although  she  will  be  out  in 
a  few  days. 


Dr.  Moses  J.  Fine,  class  of  1910,  surgeon  of 
the  steamer  Voltunro  of  the  Uranium  Line,  was 
married  to  Miss  Lillian  Eilman  of  183  Bergen 
street,  Brooklyn,  in  Knights  of  Pythias  Hall,  432 
Hopkinson  avenue,  Brooklyn,  on  December  31, 
1912.  Dr.  Fine's  fiancee  had  decided  that  if  the 
marriage  could  not  take  place  in  1912  she  would 
wait  until  1914,  for  she  would  not  "tempt  fate" 
by  a  wedding  in  1913.  Dr.  Fine's  ship  came  to 
Brooklyn  from  Rotterdam,  and  the  trip  was  ex- 
ceedingly rough,  and  time  after  time  the  gales 
retarded  the  steamer's  progress.  When  the  boat 
docked  at  Halifax,  several  Halifax  physicians 
offered  to  take  his  place  so  he  could  proceed  to 
New  York  by  rail,  but  he  stuck  to  his  post,  and 
although  the  ship  was  two  days  late,  won  the 
race  with  time,  and  was  married  two  hours  after 
the  boat  reached  port. 


DEATHS 


After  his  graduation  he  went  back  to  Queen  A;  mes 
county  to  practice,  remaining  there  till  1888. 
Then  he  came  to  Baltimore  and  established  the 
Winchester  Manufacturing  Co.,  manufacturing 
largely  his  own  preparations.  This  company  was 
recently  absorbed  by  Sharp  &  Dohme.  He  mar- 
ried Miss  Alice  Bryan,  daughter  of  William  R. 
Bryan,  of  Queen  Anne's.  He  is  survived  by  his 
widow  and  two  sons,  Clifford  B.  and  William 
Valentine  Winchester,  all  of  Baltimore,  and  a 
brother,  Julian.  R.  Winchester,  and  a  sister,  Mrs. 
Julia  W.  White,  both  of  Queen  Anne's. 


Dr.  Benjamin  T.  Winchester,  class  of  1875, 
died  at  his  home  in  Windsor  Hills,  January  14, 
1913,  after  an  illness  of  10  weeks,  aged  62  years. 
He  was  born  in  185 1  in  Queen  Anne's  county,  the 
son  of  I.  W.  and  Josephine  R.  Winchester.  Dr. 
Winchester  was  educated  in  the  Yan  Metter-Mon- 
roe  private  school  in  Carroll  county,  later  entering 
the  medical  school  of  the  University  of  Maryland. 


Dr.  Alfred  B.  Giles,  class  of  1880,  of  Forest 
and  Callaway  avenues,  was  stricken  with  an  at- 
tack of  the  heart  while  taking  a  bath,  and  died 
shortly  afterwards.  He  called  to  his  wife  to  bring 
some  aromatic  spirits  of  ammonia.  She  hurried 
to  the  bathroom  and  found  him  unconscious.  Dr. 
Arthur  L.  Fehsenfeld,  class  of  1909,  was  hur- 
riedly called,  but  by  the  time  he  reached  the  house 
Dr.  Giles  was  dead.  Dr.  Giles  was  50  years  of 
age,  the  son  of  the  late  Judge  William  P.  Giles, 
and  was  well  known  in  the  Walbrook  and  Forest 
Park  section  of  the  city.  He  is  survived  by  his 
wife,  Airs.  Georgia  Giles,  and  one  son,  John 
Steward  Giles. 


It  is  with  the  deepest  regret  that  we  announce 
the  death  of  Dr.  Oliver  Parker  Penning,  class  of 
1897,  of  171 1  St.  Paul  street,  on  December  28, 
191 2.  Dr.  Penning  has  been  ill  for  several  years, 
and  his  death  was  not  unexpected. 

Dr.  Penning  was  born  in  Darlington,  Harford 
county,  Maryland,  January  26,  1869,  the  son  of 
S.  E.  and  Alice  Markland  Penning.  He  was 
graduated  from  the  Havre  de  Grace  High  School 
in  1886,  and  later  entered  the  University  of 
Maryland,  graduating  in  1897.  He  was  for  a 
time  clinical  assistant  in  the  University  labora- 
tory. From  1898  to  1899  he  was  resident  phy- 
sician of  the  University  Hospital,  and  from  1902 
to  1904  assistant  demonstrator  of  anatomy  and 
assistant  in  surgery.  He  was  a  member  of  the 
Medical  and  Chirurgical  Faculty  of  Maryland, 
the  University  Hospital  Medical  Society  and  the 
Baltimore  City  Medical  Society.  He  was  presi- 
dent of  the  Splint  Club,  and  of  the  Landmark 
Lodge  of  Masons,  St.  John's  Chapter,  Crusade 
Commandery. 

Death  was  due  to  splenomyelogenous  leukemia. 
With    him   at   the    time   of  his   death   were   his 


220 


THE   HOSPITAL   BULLETIN 


mother,  Mrs.  Alice  Markland  Penning;  his  sis- 
ters, Mrs.  John  Coulbourne  and  Mrs.  Joseph  E. 
Goodwin,  and  his  brother-in-law,  Mr.  Coul- 
bourne. The  funeral  took  place  from  his  home 
on  Tuesday,  December  31.  Services  were  con- 
ducted by  Rev.  Walter  Haupt  of  Havre  de  Grace, 
and  interment  was  in  Greenmount  Cemetery.  The 
honorary  pallbearers  were  Drs.  George  H. 
Cairnes,  class  of  1864:  William  I.  Messick,  class 
of  1895;  William  J.  Coleman,  class  of  1908;  Jo- 
seph W.  Holland,  class  of  1896;  Frank  Martin, 
class  of  1886,  and  St.  Clair  Spruill,  class  of  1890, 
all  of  Baltimore. 

The  active  pallbearers  were  Drs.  Henry  B. 
Thomas,  class  of  1888  ;  Howard  E.  Ashbury,  class 
of  1903,  and  J.  Royston  Green,  class  of  1899,  and 
Messrs.  J.  C.  Taliaferro,  Hugh  L.  Pope  and  Lynn 
R.  Meekins. 

Dr.  Penning  was  of  an  extremely  lovable  dis- 
position, and  will  be  greatly  missed  in  the  Uni- 
versity set.  He  was  a  loyal  alumnus,  and  was 
always  interested  in  every  move  made  for  the 
good  of  the  University.  By  his  death  the  Univer- 
sity has  lost  a  firm  supporter.  We  extend  our 
deepest  sympathy  to  Dr.  Penning's  family. 


We  also  regret  to  announce  the  death  of  Dr. 
Richard  C.  Massenburg,  an  alumnus  of  the  class 
of  1884,  a  Confederate  veteran,  a  physician  of  the 
old  school,  and,  above  all,  a  man  of  the  very  high- 
est type.  Dr.  Massenburg  was  a  credit  to  his 
school  and  to  his  profession,  and  was  loved  by  all 
who  knew  him. 

He  was  born  in  1845  in  Hampton,  Va.,  the  son 
of  a  druggist  there.  Later  his  parents  removed  to 
Macon.  Ga.,  where  his  father  for  many  years  con- 
ducted a  drug  business  under  the  name  of  Mas- 
senburg &  Son,  an  older  brother  of  Dr.  Massen- 
burg being  the  partner.  At  the  age  of  17  he  en- 
tered the  Confederate  Army,  and  at  the  close  of 
the  war  returned  to  Macon,  later  returning  to  his 
original  home  in  Hampton.  After  spending  sev- 
eral years  there  he  came  to  Baltimore  and  entered 
the  Maryland  University,  graduating  in  1884. 
Dr.  Massenburg  located  at  once  in  Towson,  where 
he  has  been  ever  since.  He  conducted  a  drug 
store  in  connection  with  his  practice.  Of  late 
years  his  son,  George  Yellow  Massenburg,  was 
associated  with  him,  but  gave  up  pharmacy  to 
study  medicine,  graduating  in  1911.  Dr.  George 
Massenburg  was  for  a  time  resident  physician  at 


the  Church  Home  and  Infirmary,  and  recently  has 
been  a  resident  physician  in  the  Government  Hos- 
pital at  Ancon,  Panama.  He  was  on  his  way 
home  at  the  time  of  his  father's  death,  but  did  not 
reach  here  until  after  the  funeral. 

Dr.  Richard  Massenburg  was  one  of  the  prin- 
cipal organizers  of  the  Baltimore  County  Medical 
Association,  and  was  for  years  secretary  of  this 
association. 

He  was  a  member  of  the  old  Towson  Guards, 
and  later  of  the  First  Regiment.  Maryland  Na- 
tional Guard,  retiring  with  the  title  of  major.  He 
was  devoted  to  the  interests  of  the  South,  and  the 
Confederate  flag  was  always  in  evidence  in  his 
home  on  festal  occasions,  and  he  loved  the  air  of 
Dixie. 

At  the  time  of  his  death  Dr.  Massenburg  was 
health  officer  for  his  district.  He  married  Miss 
Carrie  Lee,  daughter  of  the  late  Wesley  Lee  of 
Towson.  He  is  survived  by  his  wife  and  his  son, 
Dr.  George  Massenburg,  and  one  daughter,  Mrs. 
H.  Courtenay  Jenifer  of  Towson. 

He  was  buried  on  New  Year's  Day  from  his 
home.  Services  were  conducted  by  Rev.  Dr.  W. 
H.  H.  Powers  of  Towson.  The  pallbearers  were 
all  members  of  the  Baltimore  County  Medical  As- 
sociation, and  were  Drs.  William  L.  Smith,  Harry 
M.  Slade,  class  of  1884;  James  F.  H.  Gorsuch, 
class  of  1876;  Harry  S.  Jarrett,  Josiah  S.  Bowen, 
class  of  1903,  and  Richard  F.  Gundry.  He  was 
buried  in  Prospect  Hill  Cemetery.  Towson. 


Dr.  Thomas  Clinton  Baldwin,  class  of  1804. 
died  at  his  home  in  White  Hall,  Baltimore  county, 
Maryland,  January  3,  1913,  of  Bright's  disease. 
Dr.  Baldwin  was  44  years  of  age.  He  was  born 
at  Baldwin,  Md.,  and  attended  lectures  at  the  Bal- 
timore Medical  College,  later  entering  the  L di- 
versity, graduating  in  1894.  After  his  gradua- 
tion he  located  at  Stewartstown,  Pa.,  where  he 
built  up  a  large  practice.  Later  he  removed  to 
White  Hall,  and  was  for  some  years  health  officer 
for  the  Seventh  district.  During  his  life  he  also 
practiced  for  some  years  at  York,  Pa.,  where  he 
was  Health  Commissioner.  He  married  Miss 
Ella  McDonald,  who  survives  him.  Three  sons — 
Bruce,  Donald  and  Maurice  Baldwin — also  sur- 
vive. 

lie  was  buried  on  January  6.  1913,  from  Center 
Presbyterian  Church,  White  Hall,  and  burial  was 
in  the  cemetery  adjoining  the  church. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  o£  the  Medical  Department  of  the  University  of  Maryland 
PRICE    $ l.OO    PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  608  Professional  Building,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.  VIII 


BALTIMORE,  MD.,  FEBRUARY  IS,   1913 


No.  12 


S<  'Ml'.  RECENT  TUBE  CASES. 


By  Richard  II.  Johnston,  M.M., 
Associate  Professor  of  Laryngology  in  the  Uni- 
versity of  Maryland,  Baltimore,  Md. 


In  September,  i')i-.  I  was  asked  by  a  physician 
u<  see  his  little  daughter  who.  a  week  previously, 
had  swallowed  a  penny.  The  father,  thinking 
that  the  foreign  body  would  pass  through,  paid 
no  special  attention  to  the  incident  until  the 
mother  noticed  that  the  little  patient  was  having 
difficulty  in  swallowing  and  that  she  would  awake 
several  times  at  night  fretting  with  pain  in  her 
throat.  The  father  then  had  X-ray  pictures  made, 
which  showed  a  shadow  at  about  the  seventh 
cervical  vertebra,  or  at  the  upper  end  of  the 
esophagus.  The  patient  was  taken  to  the  L'ni- 
versity  Hospital,  where  she  was  immediately  pre- 
pared for  operation.  The  preparation  in  these 
crses  is  very  simple.  The  patient  is  taken  to  the 
operating-room  in  her  street  clothes  and  wrapped 
in  a  sheet  which  is  securely  pinned  so  as  to  re- 
duce movements  of  the  arms  and  legs  to  a  mini- 
mum. She  is  then  placed  on  the  table  with  the 
head  straight  and  not  over  the  end  of  the  table. 
An  assistant  holds  the  head  while  the  arms  and 
legs  are  attended  to  by  a  nurse.  Xo  anesthetic 
is  used  :  this  point  cannot  be  too  stronglv  em- 
phasized since  cocaine  is  dangerous  and  ether  is 
unnecessary,  except  possibly  in  those  cases  in 
which  the  foreign  body  has  sharp  edges  or  hap- 
pens to  be  a  pin.  The  patient  was  placed  on  the 
table  as  above  described;  with  the  head  held 
straight,  Jackson's  modified  child's  laryngoscope 
was  passed;  this  tube  measures  \-  cm.  in  length 
anil  10  mm.  in  the  inside  diameter.  When  the 
larynx  was  reached  the  spatula  end  of  the  tube 
was  honked  around  the  cricoid  cartilage,  which 
was    easily    raised    and    the    upper    end    of    the 


esophagus  exposed.  The  penny  was  immediately 
seen  lying  slightly  posterior  to  the  middle  line 
with  edges  transverse.  Forceps  were  introduced 
through  the  tube,  the  penny  seized  and  promptly 
removed.  The  operation  did  not  take  two  min- 
utes. The  little  patient  was  not  hurt,  the  mem- 
brane was  not  injured,  and  ten  minutes  after  the 
operation  we  took  her  home  in  her  father's  auto- 
mobile. She  made  an  uneventful  recovery.  I 
have  described  this  case  in  detail  to  emphasize 
the  value  of  the  straight  position  of  the  head  ami 
the  advantage  of  using  a  short  instrument  in 
upper  esophagoscopy.  This  combination  makes 
esophagoscopy  easy  and  practically  free  from  dan- 
ger. For  four  years  1  have  used  the  straight 
position  of  the  head  in  direct  laryngoscopy,  and 
for  some  time  in  upper  esophagoscopy  in  chil- 
dren, hut  only  recently  have  laryngologists 
adopted  it  to  an\-  extent.  It  simplifies  the  work, 
and  I  find  that  as  my  experience  increases  I  am 
able  to  work  oftener  without  anesthesia,  local  or 
general. 

Case  II. — In  September,  1912,  Mr.  S.,  39  years 
old,  was  referred  to  me  by  Dr.  J.  F.  Hempel. 
The  patient  had  always  led  an  active  life  and  had 
been  a  powerful  man.  Mis  normal  weight  was 
[86  pounds.  Three  months  before  I  saw  him  he 
noticed  that  certain  foods  did  not  seem  to  pass 
down  as  well  as  formerly.  The  difficulty  in  swal- 
lowing increased  rapidly,  and  when  1  saw  him  at 
the  Presbyterian  Hospital  it  was  painful  to  see 
the  muscular  contractions  of  the  face  and  neck 
when  he  attempted  to  swallow  milk.  His  weight 
was  143  pounds.  Mis  throat  was  so  sensitive 
that,  even  after  the  injection  of  morphine  and 
atropine,  my  attempt  to  examine  him  under  local 
anesthesia  failed.  The  next  day  in  the  presence  of 
Dr.  Murphy  of  Cincinnati  and  Dr.  Arrowsmith 
of  Brooklyn,  we  examined  him  under  ether  anes- 
thesia and  found  a  hard,  firm  stricture  about  an 
inch   below    the   cricoid    cartilage.      The   smallest 


222 


THE   HOSPITAL   BULLETIN 


Hunt's  bougie  was  passed  through  the  esophago- 
scope  and  coaxed  through  the  stricture.  We  then 
found  a  second  and  a  third  stricture,  both  of 
which  were  successfully  dilated.  The  next  day 
the  patient  swallowed  milk.  Because  of  the  three 
strictures,  it  has  been  difficult  to  pass  a  French 
bougie,  but  with  a  Bunt's  bougie  the  esophagus 
has  been  kept  open,  so  that  the  patient  now  eats 
everything1.  lie  has  gained  13  pounds  and  feels 
well  and  strong.  We  expect  to  use  French  bou- 
gies shortly.  This  case  is  reported  because  benign 
stricture  at  the  upper  end  of  the  esophagus  in 
adults  is  rare,  and  because  of  the  successful  treat- 
ment of  the  three  strictures  by  a  simple  method. 
One  of  the  interesting  features  of  the  case  was 
that  no  cause  could  be  found  for  the  obstruction. 
It  may  be  well  to  emphasize  the  dangers  of  cut- 
ting and  forcibly  divulsing  benign  strictures  of 
the  esophagus.  In  an  experience  of  five  years  I 
have  had  no  bad  symptoms  from  the  use  of  Bunt's 
bougies  except  pain  or  soreness  for  a  few  days 
after  the  first  treatment.  In  children  I  use  the 
two  smallest,  and  in  adults  the  three  smallest 
bougies  at  the  first  treatment.  No  attempt  is 
made  to  force  the  stricture  for  fear  of  setting  up 
fatal  mediastinitis.  If  after  the  first  treatment,  a 
small  French  bougie  will  not  pass  easily,  re- 
course is  had  to  Bunt's  bougies  again.  These  are 
passed  every  five  days  until  all  swelling  has  sub- 
sided and  no  blood  appears.  Then  the  French 
bougie  is  tried  again  and  usually  passes  without 
trouble.  The  patient  is  then  taught  to  pass  the 
bougie,  which  he  uses  at  home  regularly  for  a 
time  and  later  every  six  months.  I  have  always 
believed  that  cutting  benign  strictures  or  trying 
to  force  dilatation  by  powerful  divulsors  through 
the  esophagoscope  is  dangerous,  because  we  have 
no  means  of  knowing  just  what  we  are  doing. 
With  graduated  olive  points  beginning  with 
1  mm.  we  can  always  tell  what  the  dilatation 
will  be.  (  )ne  can  swallow  through  a  small  open- 
ing, and  it  is  not  necessary  to  try  to  produce  a 
lumen  equal  to  the  normal  esophagus.  I  have 
kept  in  touch  with  all  my  stricture  cases,  and,  ex- 
cept for  the  slight  trouble  of  passing  the  bougie 
every  few  months,  they  are  all  well. 

Case  111. — In  July,  i<)i2.  a  boy,  seven  years 
old,  was  brought  to  me  from  Crisfield.  Mel.,  with 
the  history  of  having  inspired  a  grain  of  corn 
four  days  previously.  His  breathing  was  labored, 
temperature  was  102  degrees  and  pulse  120.  The 
patient  had  a  hoarse,  croupy  cough;  the  respira- 


tory murmur  over  the  right  lung  was  almost 
abolished.  The  boy  was  taken  to  the  Presby- 
terian Hospital,  ether  was  administered  and  the 
bronchoscope  passed  with  the  head  straight  on  the 
table.  My  experience  with  the  straight  position 
of  the  head  convinces  me  that  the  bronchoscope 
is  more  easily  passed  than  with  the  head  over  the 
end  of  the  table,  as  is  advocated  by  most  opera- 
tors. After  the  patient  is  anesthetized,  the  separa- 
ble speculum  is  passed  and  the  larynx  brought  into 
view.  The  bronchoscope  is  then  passed  through 
the  laryngoscope,  and  with  a  gentle,  twisting  mo- 
tion slips  between  the  vocal  cords.  The  laryngo- 
scope is  removed  while  an  assistant  steadies  the 
bronchoscope ;  the  head,  which  together  with  the 
body  is  raised  on  cushions,  is  allowed  to  drop  to 
the  plane  of  the  table ;  the  operator  takes  his  seat 
at  the  end  of  the  table  and  pushes  the  tube  fur- 
ther down,  controlling  the  movements  of  the  head 
with  the  free  hand.  In  this  method  it  is  remark- 
able how  little  extension  of  the  head  is  necessary 
for  successful  work.  No  assistant  is  required  to 
hold  the  head  over  the  end  of  the  table,  and  the 
operator  has  a  comfortable  seat  which  enables  him 
to  work  more  quickly.  In  very  young  children 
the  cushions  are  used,  but  the  head  is  dropped 
before  the  bronchoscope  is  passed.  The  grain  of 
corn  was  located  wedged  in  the  depths  of  the 
right  bronchus;  it  was  seized  with  forceps  and 
removed.  The  patient  recovered  promptly.  The 
grain  of  corn  was  swollen  twice  its  natural  size. 

Case  IV. — A  little  boy,  two  years  old,  inspired 
a  watermelon  seed  two  weeks  before  I  saw  him. 
He  had  a  croupy  cough  and  his  temperature  was 
eleyated.  He  was  placed  on  the  table  and  the 
larynx  examined  with  the  head  straight.  Noth- 
ing abnormal  being  found,  a  5  mm.  tracheoscope 
was  passed,  and  as  soon  as  it  was  pushed  between 
the  vocal  cords  the  foreign  body  was  seen.  He- 
cause  it  was  so  slippery,  it  was  grasped  with  diffi- 
culty, but  was  finally  removed.  After  the  opera- 
tion edema  of  the  glottis  developed  and  a  tra- 
cheotomy had  to  be  done.  He  wore  the  tube  four 
days,  and  after  its  removal  made  an  uneventful 
recovery.  1  wish  to  emphasize  the  ease  with 
which  the  larynx  can  be  examined  in  children 
with  the  head  straight  on  the  table.  The  position 
is  the  same  as  for  upper  esophagoscopy  described 
above.  The  instrument  is  the  same  and  is  intro- 
duced as  easily  in  infants  as  in  older  children. 
Anesthetics  are  never  used.  For  the  removal  of 
foreign  bodies  or  papillomata  in  the  larynges  of 


THE   HOSPITAL   BULLETIN 


223 


children,  the  method  is  far  superior  to  extension 
with  the  bead  held  over  the  end  of  the  table.  The 
greatest   advantage   of   the   method    is   that   no 

trained  assistant  is  required,  since  the  head  can  he 
held  properly  by  anyone.    The  great  disadvantage 

of  the  "Boyce  position"  is  the  fact  that  one  must 
have  special  training  to  hold  the  head  just  right. 
Case  V. — This  case  illustrates  the  ease  with 
which  tumors  may  be  removed  from  any  part  of 
the  larynx  in  adults  with  the  right  instrument  and 
the  proper  position  of  the  head.  For  a  long  time 
I  have  been  doing  direct  laryngoscopy  in  the  sit- 
ting position  with  the  head  straight,  which  gives 
the  advantage  of  complete  relaxation  of  the  neck 
muscles.  This  position,  with  the  use  of  the  instru- 
ment described  above  or  the  small,  separable 
speculum,  makes  it  possible  to  examine  and  oper- 
ate in  all  larynges  with  ease.  Most  direct 
laryngoscopes  are  too  large,  and  to  make  the 
work  more  difficult  are  introduced  between  the 
incisor  teeth.  I  nder  these  conditions,  unless  the 
patient  has  a  long  neck  and  small  teeth,  it  is  prac- 
tically impossible  to  see  the  entire  larynx  without 
pulling  so  forcibly  on  the  speculum  as  to  cause 
pain.  If,  perchance,  the  operator  sees  the  growth. 
he  is  in  such  a  cramped  position  successful  re- 
moval is  very  difficult.  These  difficulties  are 
removed  and  the  examination  made  almost  as 
easily  as  with  the  mirror  by  using  the  small  specu- 
lum and  passing  it  between  the  right  or  left  bi- 
cuspid teeth  with  the  head  straight,  or  nearlv  so. 
and  turned  slightly  to  right  or  left.  The  tube  is 
carried  quickly  down,  the  end  hooked  around  the 
epiglottis  and  the  entire  larynx  exposed.  Prac- 
tically no  force  is  exerted  on  the  instrument  and 
often  its  weight  exposes  the  larynx.  The  instru- 
ments that  I  use  are  made  with  separable  handles, 
so  that  the  vertical  part  of  the  handle  can  be  re- 
moved when  one  wishes  to  examine  a  patient  in 
the  prone  position.  The  patient  was  a  man,  30 
years  old,  who,  four  years  ago.  had  a  papilloma 
removed  from  the  left  vocal  cord  by  the  indirect 
or  mirror  method.  For  three  years  his  voice  was 
clear.  About  a  year  ago  huskiness  made  its 
appearance,  and  this  was  soon  followed  by  hoarse- 
ness. Because  of  a  large  uvula  and  an  over- 
hanging epiglottis,  a  satisfactory  mirror  examina- 
tion was  impossible.  A  growth,  apparently  on 
the  left  vocal  cord,  was  seen,  and  to  this  I  at- 
tributed the  hoarseness.  Following  my  usual  cus- 
tom, I  anesthetized  the  larynx  with  20  per  cent. 
alvpin    solution    for    examination    and    operation 


through  the  direct  laryngoscope.  The  result  of 
the  examination  shows  how  superior  the  tube  is 
to  the  mirror  in  patients  with  a  low-hanging 
epiglottis.  The  patient  was  seated  on  a  low  stool 
with  head  straight  ami  turned  slightly  to  the 
right.  The  small  10  mm.  tube  was  introduced 
between  the  left  bicuspid  teeth  and  passed  down 
to  the  epiglottis,  which  was  hooked  forward,  ex- 
posing the  larynx.  The  tumor,  which  was  indis- 
tinctly seen  with  the  mirror,  proved  to  be  under 
the  cord  and  not  on  it.  On  the  right  false  cord  a 
large  tumor  mass,  extending  down  over  the  true 
cord  and  preventing  proper  approximation  of  the 
cords,  was  seen.  This  growth  was  causing  the 
hoarseness.  With  Pfau's  universal  handle  and 
different  cutting  tips,  the  masses  were  quickly  re- 
moved. Some  of  the  growth  was  attached  to  the 
right  cord  and  a  small  tumor  was  located  in  the 
anterior  commissure.  After  removal  alcohol  was 
applied.  These  applications  will  be  continued 
some  time  to  destroy  any  small  particles  which 
may  be  left. 

The  apparent  difficulties  connected  with  direct 
laryngoscopy,  bronchoscopy  and  esophagoscopy 
have  prevented  many  laryngologists  entering 
these  fields.  Instead  of  trying  to  simplify  the 
work,  it  seems  to  me  that  new  instruments  are 
being  introduced,  which  tend  to  greater  difficul- 
ties for  the  beginner.  With  a  few  instruments 
one  can  do  successful  work.  For  the  larynx  no 
tube  is  as  satisfactorv  as  the  small,  modified  Jack- 
son model  with  the  light  at  the  end.  For  bron- 
choscopy many  laryngologists  prefer  the  Bruen- 
ing's  hand  light,  because  the  light  carrier  in  the 
Jackson  tube  is  liable  to  become  clouded  with 
blood  or  mucus.  This  objection  is  overcome  by 
having  a  second  carrier  loaded  to  introduce  if 
occasion  demands.  I  can  handle  the  Jackson  tube 
with  greater  ease  and  prefer  it  for  that  reason. 
For  upper  esophagoscopy  in  children  no  instru- 
ment is  better  than  the  modified  Jackson  tube, 
because  of  its  ease  of  introduction  with  the  head 
straight.  The  only  objection  to  it  is  that  one  can- 
not see  far  ahead  of  the  tube  because  the  light  is 
not  strong  enough.  I  have  tried  all  manner  of 
tubes,  and  have  come  back  to  Jackson's  models 
because  I  think  they  are  the  simplest  and  easiest 
to  handle.  When  one  learns  direct  laryngoscopy 
by  simple  methods,  bronchoscopy  and  esoph- 
agoscopv  are  easy.  As  the  work  is  simplified  it 
becomes  more  and  more  fascinating.  It  will  never 
reach   its  highest  grade  of   development   for   the 


224 


THE    HOSPITAL    BULLETIN 


greatest    number,    however,    until    simplicity    of 

methods  and  instruments  is  insisted  upon. 

I  have  notes  of  three  more  cases  which  are  of 

some  interest. 

A  male,  54  years  old,  was  referred  to  me  with 
the  history  of  trouble  in  deglutition  of  five  years' 
duration.  His  trouble  was  peculiar,  in  that  food 
which  had  been  swallowed  24  hours  before  would 
come  up  entirely  undigested  and  almost  in  its 
original  state.  Sometimes  for  days  he  would 
swallow  perfectly.  The  continued  lack  of  nour- 
ishment pulled  him  down  from  a  strong  healthy 
man  to  a  mere  shadow.  At  times  pain  was  severe. 
Before  the  examination  he  was  given  morphine 
and  hyoscine  hypodermically.  The  esophagoscope 
was  easily  passed  and  nothing  found  until  the 
cardia  was  reached.  Here  two  distinct  openings 
were  seen,  one  of  which  to  the  left  led  into  a 
pocket  two  or  three  inches  in  depth,  which  was 
filled  with  milk  and  undigested  food.  After 
pumping  the  pocket  out  the  mucous  membrane 
could  he  seen.  To  the  right  the  puckered  appear- 
ance of  the  cardia  was  distinct.  To  enter  the 
diverticulum  the  upper  end  of  the  esophagus  had 
to  be  carried  to  the  right.  When  the  pocket  was 
emptied  the  walls  immediately  collapsed,  so  that 
the  opening  was  difficult  to  find.  The  esoph- 
agoscope was  easily  pushed  into  the  stomach. 

Some  weeks  ago  a  man  came  to  the  University 
Hospital  with  the  history  of  having  swallowed 
almost  nothing  for  three  weeks.  lie  had  had 
trouble  for  a  long  time;  there  were  times  when  he 
could  swallow  without  difficulty.  Hut  for  three 
weeks  he  had  vomited  constantly.  At  the  request 
of  Dr.  Zueblin  I  examined  his  esophagus  under 
deep  ether  anesthesia.  Local  anesthesia  was 
deemed  inadvisable,  because  from  the  man's  high- 
ly nervous  state  we  thought  .of  a  cardiospasm. 
Repeated  attempts  to  pass  a  stomach  tube  had 
failed.  The  esophagoscope  showed  that  the  upper 
part  of  the  esophagus  was  normal.  When  the 
cardia  was  reached  the  examination  of  its  walls 
showed  no  pathological  lesion,  and  the  ease  with 
which  the  tube  was  pushed  into  the  stomach  made 
the  diagnosis  of  cardiospasm.  The  pink  mucous 
membrane  of  the  stomach  contrasted  strongly 
with  the  pallor  of  the  esophagus. 

In  July,  ii)i2,  I  was  consulted  by  Miss  R.,  30 
years  old,  for  a  stubborn  cough  of  six  months' 
duration  which  had  followed  "grip."  She  bad 
taken  all  the  usual  cough  remedies  with  only 
temporary  benefit.    A  bronchoscopic  examination 


showed  inflammation  of  the  trachea,  which  so 
often  is  a  sequel  of  "grip"  and  which  can  usually 
be  cured  by  the  application  of  silver  nitrate  2  to 
10  per  cent,  solution.  Six  applications  relieved 
the  cough  entirely. 

Before  closing  I  wish  to  refer  briefly  to  a  case 
of  papillomata  of  the  larynx  in  a  child.  Before 
the  introduction  of  the  direct  larvngoscope,  such 
cases  were  always  a  bugbear  to  the  laryngologist. 
So  difficult  of  treatment  were  they  that  splitting 
the  larynx  was  advocated  by  some  of  the  more 
radical  throat  surgeons,  and  the  operation  was 
done  with  impairment,  if  not  ruin,  of  the  voice, 
because  in  small  larynges  it  is  difficult  to  ap- 
proximate the  two  halves  properly  or  so  much 
tissue  is  destroyed  by  this  radical  procedure.  The 
treatment  now  is  along  logical  lines,  thanks  to  the 
direct  laryngoscope.  I  have  no  hesitancy  in  say- 
ing that  it  is  never  necessary  to  open  the  larynx 
for  the  removal  of  these  growths,  and  that  it  is 
rare  that  a  tracheotomy  has  to  be  done.  It  is, 
however,  better  to  perform  the  latter  operation  if 
the  child  is  in  danger  of  suffocation,  because  the 
larynx  can  be  cleaned  out  in  two  or  three  sittings 
through  the  direct  laryngoscope  and  the  tracheal 
tube  removed  permanently.  The  patient  was  a 
cln'lil,  [9  months  old,  referred  to  me  by  Dr.  A.  M. 
Shipley  for  aphonia  of  several  months'  duration 
and  attacks  of  cyanosis,  especiallv  on  crying.  At 
the  University  Hospital  the  boy  was  pinned  in  a 
sheet  and  examined  with  the  direct  laryngoscope, 
the  head  being  held  straight  on  the  table.  The 
diagnosis  of  multiple  papillomata  was  made  and 
most  of  the  growth  at  once  removed  through  the 
tube  with  I 'fan's  forceps.  Two  such  operations 
resulted  in  the  complete  removal  of  the  tumors. 
Applications  of  alcohol  were  made  to  the  larynx 
once  weekly,  with  the  result  that  the  growths 
disappeared  completely,  and  up  to  this  time — one 
year  after  the  first  operation — have  not  returned. 
This  result  is  exceptional,  for  most  cases  have  to 
be  treated  several  years.  I  mention  this  case  sim- 
plv  to  condemn  laryngotomy  in  the  treatment  of 
tumors  of  the  larynx,  except,  of  course,  in 
malignancy. 

Appendix. — Recent  experience  has  convinced 
me  that  the  high  frequency  spark  is  the  best 
treatment  for  papillomata  of  the  larynx  in  adults 
and  in  children.  In  a  patient,  07  years  old,  with 
a  large  papilloma  of  the  right  laryngeal  surface 
of  the  epiglottis,  two  applications  of  the  spark  a 
week  apart  caused  the  total  disappearance  of  the 


THE    HOSPITAL   BULLETIN 


growth,  so  that  in  a  month  it  was  impossible  to 
tell  whence  it  bad  sprung.  The  microscope  did 
not  show  malignancy,  Init  such  growths  in  old 
people  are  practically  the  precursor  of  cancer 
from  degeneration  if  they  arc  not  promptly  and 
radicalh  removed.  The  spark  is  applied  through 
the  direct  laryngoscope  after  anesthetizing  the 
membrane  with  alypin  (20  per  cent,  solution). 
In  my  work  I  use  the  spark  about  a  quarter  of 
an  inch  long,  because  with  this  length  it  is  under 
absolute  control.  In  multiple  papillomata  in  chil- 
dren it  is  just  as  easily  applied  through  the  direct 
laryngoscope  without  anesthesia  by  holding  the 
bead  straight  on  the  table.  The  tumors  are 
burned  with  the  spark,  turn  pale  and  disappear. 
The  normal  tissue  is  not  injured  unless  the  spark 
contact  is  prolonged. 

807  North  Charles  street. 


PREP  \RATK  IN  (  >F  PATIENT  FOR  OPER- 
ATK  )N. 


By  George  Loutrell  Timanui 

Junior  Medical  Student. 


When  patient  enters  hospital  for  operation,  a 
thorough  examination  is  held,  and  any  abnormal 
conditions  are  treated  by  regular  routine  methods. 

Patient  is  disrobed  and  placed  in  a  clean  bed 
with  hygienic  surroundings. 

Methods  used  in  different  hospitals  will  be  read 
at  end  of  this  sketch,  and  contain  most  informa- 
tion that  could  be  obtained  on  the  subject. 

The  most  important  issue  is  the  preparation  of 
the  site  of  operation.  This  is  a  most  difficult 
process  to  render  skin  absolutely  sterile,  due  to 
the  existence  of  hair  follicles  and  ducts  of  seba- 
ceous and  sudoriferous  glands  which  present 
crevices  for  the  lodgment  of  myriads  of  micro- 
organisms. 

The  process  of  sweating  is  one  of  the  most  effi- 
cient means  of  rendering  the  skin  sterile.  The 
longer  this  is  continued  the  more  perfect  is  the 
sterilization. 

Infection  is  the  outcome  of  fertilization,  and  it 
is  the  surgeon's  endeavor  to  limit  the  infective 
substance,  thus  accomplishing  septic  results. 

Infection  is  rare  where  large  amounts  of  fluids 
are  used,  provided  the  same  are  sterile,  due  to  the 


dilution  of  the  toxines.  It  is  therefore  better,  if 
this  is  true,  to  apply  plenty  of  sterile  water  than 
so  many  chemicals. 

The  hair  on  the  site  of  operation  should  be  re- 
moved. This  is  accomplished  by  shaving  the 
parts  after  the  application  of  soap  and  water. 
This  will  also  remove  scales  of  the  skin  and  oil 
that  may  be  present  on  the  surface.  Care  should 
be  taken  in  shaving  not  to  cause  any  scratches, 
thus  offering  sites  for  infection. 

Dr.  W.  E.  Dreyfuss  has  given  an  efficacious 
method  for  the  removal  of  hair.  The  mixture  is 
as  follows:  Barii  sulphid,  2*,  parts;  saponis  pul- 
\is.  5  parts :  talci  veneti  pulv..  35  parts;  benzalde- 
hydi.  q.s.  Take  1  oz.  of  powdet,  add  3  oz.  of 
water;  apply  paste  thickly  with  shaving  brush; 
allow  to  remain  five  minutes,  then  with  a  sponge 
and  sterile  water  moisten,  and  at  the  end  of  an- 
other five  minutes  wash  off  mass;  hair  will  come 
away  with  water  applied. 

After  hair  has  been  successfully  removed,  wash 
parts  thoroughly  with  tinctura  of  green  soap  and 
sterile  water.  Gauze  or  a  rubber  sponge  should 
be  used  in  the  washing.  Do  not  use  a  brush. 
Parts  should  be  handled  gently.  Ether  should 
next  be  applied,  but  should  not  be  allowed  to  re- 
main, for  it  boils  at  temperature  of  the  body,  and 
may  burn  the  part.  This  will  dissolve  all  remain- 
ing fats  and  oils  present.  Wash  ether  away  with 
alcohol,  and  then  cover  parts  with  sterile  gauze, 
over  which  is  placed  a  pad  of  cotton  and  bandages 
sufficient  to  hold  in  place. 

Monyhan  cleanses  skin  with  soap  and  water, 
then  applies  a  compress  and  allows  same  to  re- 
main 24  hours.  This  compress  is  composed  of 
2-3  layers  of  lint  soaked  in  a  I  per  cent,  formalin 
solution,  a  1-60  part  carbolic  acid  solution  or  a 
r-2000  bichloride  of  mercury.  The  two  latter 
solutions  are  apt  to  cause  irritation.  A  second 
washing  is  given  after  24  hours. 

If  there  are  any  cracks  or  fissures  in  the  skin, 
these  should  be  rendered  sterile  with  carbolic  ap- 
plied with  a  cotton  swab,  and  the  acid  neutralized 
after  a  few  minutes'  application  with  alcohol. 
The  actual  cautery  may  lie  applied  for  this  pur- 
pose. 

The  room  in  which  patient  is  confined  should 
be  regular  in  temperature,  and  not  too  hot. 

The  body  should  be  covered  with  a  sterile  sheet. 
Hair  should  be  wrapped  in  a  sterile  towel.  A 
shirt  opening  in  the  back  is  best,  so  it  can  be  easily 


226 


THE    HOSPITAL    BULLETIN 


removed.    Long  linen  stockings  should  be  placed 
on  the  patient. 

CHOICE    OF   ANESTHETICS. 

There  are  certain  symptoms  present  in  differ- 
ent individuals  who  are  presented  for  operation 
which  contraindicate  the  use  of  certain  drugs  or 
anesthetics.  In  diseases  of  the  kidney  ether  is 
likely  to  cause  suppression  of  the  urine  and  thus 
cause  coma  and  death.  In  diseases  of  the  respira- 
tory tract,  as  asthma,  emphysema,  bronchitis,  the 
vapors  of  ether  are  very  irritating  and  likely  to 
aggravate  the  condition.  In  operations  on  the 
face  and  mouth,  where  it  is  impossible  to  keep 
patient  anesthetized,  in  certain  sensitive  mucous 
membranes  of  the  respiratory  tract  irritation  to 
same  may  cause  rapid  rate  of  respiration  and 
cough  in  anesthesia.  All  of  these  conditions  are 
contraindications  to  ether,  and  are  best  treated 
by  chloroform. 

In  any  disease  of  heart,  chloroform  is  always 
contraindicated,  and  ether  should  be  given. 

Some  people  cannot  take  ether  or  chloroform. 
These  should  be  given  nitrous  oxide,  which  will 
render  patient  unconscious  within  30  seconds  to 
2  minutes.  There  are  no  after-effects.  Ether  is 
often  preceded  by  nitrous  oxide. 

A.  C.  E.  mixture,  or  3  parts  of  ether,  2  of  alco- 
hol and  1  of  chloroform,  is  sometimes  given. 

In  the  giving  of  anesthetics  the  simplest  meth- 
ods possible  are  those  most  employed.  The  cloth- 
ing should  be  loose  about  neck  and  body  should 
not  be  in  cramped  position.  Patient  lying  on  back 
with  arms  folded  across  chest.  Tongue  should 
be  kept  forward. 

LOCAL   ANESTHESIA. 

These  are  many  in  number.  The  application 
of  cold  to  a  part,  spraying  of  ether  to  part  or 
combination  of  ether,  chloroform  and  menthol. 
The  application  of  ethyl  chloride,  otherwise 
known  as  kelene,  to  the  part  to  be  anesthetized  is 
a  satisfactory  method.  Part  becomes  reddened, 
then  white.  These  methods  are,  however,  only 
fit  for  skin  operations. 

Hvdrochlorate  of  cocaine,  discovered  by  Keller 
of  New  York,  either  applied  locally  by  drop- 
ping, as  in  operations  on  the  eye.  or  by  the 
subcutaenous  injection  a  per  cent,  of  Y2-2  is  the 
agent  most  frequently  employed  for  this  purpose. 
An  Esmarch  bandage  applied  above  the  point  of 


injection  will  prevent  cocaine  intoxication,  and 
will  at  the  same  time  increase  anesthetizing 
power.  Before  injecting  the  cocaine  the  parts 
to  be  injected  should  be  rendered  sterile,  also  the 
instrument  used.  The  needle  should  be  pushed  in 
deeply  and  fluid  expelled  on  withdrawal  of 
needle,  most  being  deposited  directly  beneath  the 
skin. 

Corning  in  1885  described  a  method  of  inject- 
ing 8-15  111.  of  a  2  per  cent,  sterile  solution  of 
cocaine  in  the  sub-arachnoid  space.  Anesthesia 
usually  extends  as  high  as  the  umbilicus  and  may 
go  as  high  as  the  nipples.  This  will  allow  opera- 
tion on  the  lower  extremities,  as  well  as  on  the 
organs  of  the  pelvis,  uterus,  bladder,  ovaries,  etc. 

University  Hospital. — Routine  in  preparing- 
patient  for  operation :  Patient  on  entering  put  to 
bed,  mouth  or  rectal  temperature  taken,  pulse  and 
respiration.  Leucocyte  and  red  blood  cell  count 
taken ;  hemaglobin  and  clotting  test  performed ; 
thorough  urinary  and  physical  examination  of  pa- 
tient, laying  stress  on  heart,  kidneys  and  lungs, 
is  made. 

Night  preceding  operation  give  patient  light 
supper;  8  P.  M.  1  oz.  of  castor  oil;  '>  A.  M.  next 
morning  give  enema.  If  restless  during  night. 
give  opiates  to  quiet  patient.  Next  morning  give 
no  breakfast,  not  even  water. 

Before  going  to  operating-room  give  J4  gr. 
morphine  and  1/150  gr.  of  atropine.  Place  pa- 
tient on  table,  examine  teeth  to  see  if  false  and 
try  to  find  any  other  foreign  bodies  in  mouth. 
Lips,  nose  and  eyelids  greased  with  cold  cream 
and  eyes  are  hermetically  sealed  with  a  thin  sheet 
of  rubber,  over  which  is  placed  a  pad  of  wet  cot- 
ton, and  then  anesthetic  is  started. 

As  soon  as  patient  is  fairly  well  asleep  the  field 
of  operation  is  shaven  and  then  thoroughly 
cleaned  by  washing  with  soap  and  sterile  water 
for  15  minutes.  Then  all  remaining  soap  and 
fatty  secretions  are  dissolved  out  by  the  applica- 
tion of  ether,  which  is  in  turn  washed  off  by 
alcohol.  A  pad  saturated  with  1-1000  of  bi- 
chloride is  then  placed  over  field.  Sterile  towels 
are  then  placed  around  point  of  incision  and  pa- 
tient is  covered  with  sterile  sheets. 

Hopkins. — Routine  treatment  of  patient  for 
operation :  Starting  at  noon  the  day  before 
operation,  no  dinner  is  given;  that   is,  no  solid 


THE    HOSPITAL   BULLETIN 


227 


foods,  but  a  light  diet  of  liquids.  One  ounce  of 
Epsom  salts  is  given.  At  night  an  enema  of 
water  and  glycerine,  ,5  oz.  of  each.  Xext  morn- 
ing another  enema  and,  if  necessary,  another  be- 
fore operation.  Patient  is  compelled  to  drink 
large  quantity  of  water,  it  being  quickly  ab- 
sorbed and  will  often  prevent  necessity  of  cath- 
eterization. Patient  may  have  ounce  of  sherry 
or  cup  of  strong  coffee  if  desired  before  going 
to  operating-room. 

Before  patient  is  removed  to  operating-room,  a 
hypodermic  of  54  §T-  of  morphine  and  1/120  of 
atropine  is  given.  The  evening  before  operation 
patient  is  washed  and  field  of  operation  shaven. 
Just  before  operation,  field  is  washed  with  ben- 
zine and  painted  over  twice  with  a  3J/2  per  cent, 
solution  of  iodine. 

If  patient  has  not  been  washed  the  day  before, 
do  so  before  operation  with  alcohol  and  soap;  no 
water  is  used. 

Dr.  Cullen  of  Hopkins  suggests  shaving  to  be 
done  in  operating-room  to  prevent  worry  of  pa- 
tient. That  in  acute  appendicitis  cases  never  give 
cathartic  or  enema.  Never  give  calomel  the  day 
before ;  it  is  too  irritating. 

City  Hospital. — Routine  treatment  of  patient 
for  operation :  The  diet  up  to  24  hours  of  opera- 
tion should  not  include  anything  that  is  very 
indigestible,  but  patient  should  have  fair  amount 
of  food.  Evening  before  patient  is  given  a  full 
bath  and  field  of  operation  scrubbed  and  shaven. 
A  laxative  should  be  given  evening  before  op- 
eration. 

Morning  of  operation  a  soap  and  water  enema 
is  given.  Before  operation  patient  is  given  1/60 
gr.  of  atropine ;  no  morphine.  It  is  said  same 
seems  to  make  patient  sick  after  anesthetic.  If 
female,  a  vaginal  douche  of  1-4000  bichloride,  fol- 
lowed by  sterile  water,  is  given.  After  anesthetic 
is  started,  field  of  operation  is  again  scrubbed  with 
soap  and  water.  Gauze  is  better  than  a  brush  for 
this  purpose.  Soap  is  thoroughly  washed  off  and 
ether  is  applied,  which  is  in  turn  washed  off  by 
alcohol.  A  piece  of  gauze  saturated  with  a  one 
to  two  thousand  bichloride  solution  is  then  ap- 
plied and  allowed  to  remain  until  incision  is 
made. 


IK  )\\    LEG     GEX1      V  VRUM. 


By  A.  Schapiro, 

Junior  Medical  Student. 


We  would  appreciate  it  very  much  if  some  of 
our  readers  could  give  us  the  addresses  of  Dr. 
Howard  Steele  Holloway,  class  of  1903,  and  Dr. 
Lafayette  Lake,  class  of  1906. 


Typical  genu  varum  is  the  result  of  external 
bowing  of  the  femur  and  of  the  leg  bones.  The 
maximum  curve  is  generally  near  the  knee.  Bow- 
leg may  be  the  result  of  lateral  bending  of  the  leg 
bones  alone,  the  femur  being  unaltered.  An  an- 
terior curvature  of  the  tibia  gives  another  form 
of  bow-leg.  Operative  correction  is  demanded  in 
all  severe  cases.  Before  the  age  of  four  or  five 
years  mild  deformities  may  be  corrected  by  me- 
chanical appliances ;  after  that  age  operation  af- 
fords the  only  prospect  of  cure. 

METHODS   OF  OPERATING. 

(1)  Linear  Osteotomy. — Note  which  bone  or 
bones  are  most  seriously  affected.  Usually  in 
typical  genu  varum  both  the  femur  and  tibia  are 
badly  curved.  Note  which  part  of  the  individual 
bone  is  most  bent ;  it  is  this  point  which  must  be 
divided. 

(a)  If  osteotomy  of  the  middle  third  of  the 
femur  is  indicated,  make  a  vertical  incision 
through  the  soft  parts  down  to  the  bone  on  the 
outer  or  antero-external  side  and  proceed  as  in 
supra-cordylar  osteotomy,  in  this  case,  however, 
cutting  the  bone  from  without  inwards. 

(b)  If  the  tibia  is  most  affected  incise  vertical- 
ly the  soft  parts  down  to  the  bone  over  the  inner 
surface  of  the  bone  at  the  point  of  greatest  curva- 
ture. Introduce  the  osteotome  and  then  turn  it 
transversely  to  the  bone  and  divide  the  cortical 
bone  of  the  inner  and  outer  sides  of  the  tibia,  and 
especially  that  of  the  anterior  margin.  Be  careful 
not  to  injure  the  anterior  tibial  vessels  and  nerves 
which  lie  close  to  the  outer  surface  of  the  bone. 
Fracture  the  posterior  layer  of  the  cortical  bone 
by  manual  force.  Forcibly  fracture  or  bend  the 
fibula.  If  this  is  impossible,  palpate  the  fibula 
and  make  a  small  incision  down  to  it  through  the 
soft  structures  of  the  outer  side  of  the  leg.  In- 
troduce a  very  narrow  osteotome  and  divide  the 
bone. 

(c)  If  femur  and  tibia  are  both  markedly 
curved,  operate  on  both  at  the  same  sitting. 

The  object  of  the  surgeon  is  to  over-correct  the 
deformity.  If  division  of  one  bone  is  insufficient, 
then  divide  the  other  as  well.  If  this  is  insuffi- 
cient, repeat  the  operation  at  whatever  places  it 
may  be  needed  or  demanded.    MacEwen  has  per- 


228 


THE    HOSPITAL   BULLETIN 


formed   ten  osteotomies  on   the  same   patient   at 
the  same  sitting  and  obtained  a  good  result. 

2.  Cuneiform  osteotomy  is  particularly  suit- 
able in  cases  of  anterior  curvature  of  the  tibia. 
Render  the  limb  bloodless.  Apply  an  elastic  con- 
strictor. 

I  i  i  Make  a  longitudinal  incision  down  to  the 
bone  over  the  most  prominent  part  of  the  tibia. 
This  cut  need  not  be  much  larger  than  the  width 
of  the  chisel,  as  the  wound  in  the  soft  parts  can 
easilv  be  made  to  slide  in  various  directions  to 
expi  se  different  portions  of  the  bone.  Reflect 
the  periosteum  with  the  soft  parts.  Keep  the 
wound  open  with  retractors. 

Step  2. — With  an  ordinary  chisel  outline  the 
base  of  a  wedge  by  cutting  through  the  cortical 
bone.  This  base  corresponds  to  the  apex  of  the 
angular  deformity  and  should  be  smaller  than 
that  which  is  believed  to  be  needed.  With  the 
chisel  cut  through  the  cancellous  bone  and  re- 
move a  wedged-shaped  portion  of  bone.  Do  not 
cut  through  the  whole  thickness  of  the  bone  ;  the 
posterior  undivided  portion,  corresponding  to  the 
apex  of  the  wedge,  is  easily  fractured  by  manual 
force.  Straighten  the  limb.  If  sufficient  bone 
has  not  been  removed,  it  is  easy  to  slice  off  more 
with  a  chisel  until  the  minimum  amount,  which 
permits  of  correction,  has  been  removed.  If  the 
fibula  interferes  with  the  correction,  the  fibula 
must  be  bent  or  broken  by  manual  force  or  di- 
vided with  an  osteotome. 

Style  3. — If  the  wound  tends  to  gap  introduce 
a  few  sutures.  Apply  aseptic  dressings.  Im- 
mobilize. It  is  well  to  elevate  the  limb  for  24 
hours  or  longer.  Subsequent  treatment  same  as 
for  simple  fracture. 

3.  Oblique  Osteotomy. — In  some  eases,  espe- 
cially of  anterior  curvature  of  the  tibia,  wdiere 
there  is  much  shortening,  oblique  division  of  bone 
permits  of  elongation.  To  attain  elongation  it 
may  be  necessary  to  lengthen  the  tendo  achillis 
by  means  of  any  one  of  the  well-known  methods. 

5.     Osteoclasis. 

(a)  Manual. — Grasp  the  bone  affected  above 
and  below  the  point  of  the  greatest  curvature  and 
bend  it  straight  and  produce  a  fracture.  In  the 
very  young  a  green  stick  fracture  is  a  desirable 
lesion  to  produce.  It  is  often  necessary  to  sup- 
port the  point  of  greatest  convexity  on  a  padded 
wedge  (if  wood  before  sufficient  force  can  be  ap- 
plied. It  may  be  necessary  to  produce  multiple 
fractures. 


(  b )  Instrumental. — The  necessary  fracture  or 
bending  may  be  more  precisely  and  definitely  pro- 
duced by  an  osteoclast.  Probably  Grattan's 
osteoclast  is  the  best.  Place  the  limb  in  the  in- 
strument in  such  a  fashion  that  the  movable  arm 
is  applied  to  the  point  of  greatest  convexity,  while 
the  opposite  or  concave  side  of  the  limb  is  sup- 
ported by  two  parallel  fixed  arms  of  the  osteoclast. 
By  means  of  the  screw  make  a  movable  arm  press 
against  and  fracture  the  limb.  By  whichever 
means  the  limb  is  straightened,  it  must  be  fixed 
in  good  position  by  plaster  of  Paris  or  apparatus 
and  treated  as  an  ordinary  fracture.  In  the  treat- 
ment of  bow-legs  osteotomy  and  osteoclasis  seem 
to  give  about  equally  good  results. 


The  condition  of  Dr.  Charles  Wellman  Mitchell, 
dean  of  the  medical  school  of  the  University  of 
Maryland  from  1897  to  1900,  and  professor  of 
children's  diseases  and  associate  professor  of 
medicine  at  the  same  institution,  who  has  been 
dangerously  ill  of  the  grip  at  his  home,  0  E. 
Chase  street,  is  said  to  be  much  improved.  Until 
the  appointment  of  Dr.  Ernest  Zueblin  last  fall 
Dr.  Mitchell  was  full  professor  of  medicine  at  the 
University.  He  is  popular  among  the  student 
body  as  well  as  the  faculty  of  the  University  and 
the  staff  of  the  hospital. 

The  Baltimore  Sun  has  the  following  to  say 
regarding  Dr.  Mitchell: 

'"lie  is  a  member  of  the  modern  school  which 
holds  to  the  tenet  that  a  physician  can  never  af- 
ford to  give  up  his  books.  Like  many  others  in 
this  country,  he  acquired  an  excellent  knowledge 
of  German  many  years  ago,  and  by  that  means 
he  keeps  in  close  touch  with  the  latest  discoveries 
in  the  profession  in  Berlin,  Vienna  and  the  other 
centers  of  learning  in  Austria  and  Germany.  He 
has  taken  courses  at  some  of  the  German  univer- 
sities. 

"lie  was  a  classmate  of  Woodrow  Wilson  at 
Princeton,  and,  although  he  has  never  made  a 
stump  speech  in  behalf  of  Governor  Wilson,  he 
has  spoken  forcefully  of  him  wherever  he  has 
gone.  1  )r.  M  itchell's  writings  are  marked  by  their 
purity  of  English,  lucidity  of  style  and  thorough 
grasp  of  his  subject." 


Dr.  J.  Holmes  Smith.  Jr..  class  of  1005,  has 
been  commissioned  an  assistant  surgeon  in  the 
I  nited  States  Public  Health  Service. 


THE    HOSPITAL    BULLETIN 


->->  i 


THE   HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surjjery 

PUBLISHED  BY 

THE  HOSPITAL  BULLETIN   COMPANY 

008  Professional  Building 

Baltimore,  Vn. 


Subscription  price,     .     .     .     $1.00  per  annum  in  advance 

Reprints   furnished   at   cost.     Advertising   rates 

submitted  upon  requtst 


Nathan  Winslow,  M.D.,  Editor 


Baltimore,  February  15,  1913. 


THE   NEW  PROVOST  AND  HIS   PREDE- 
CESSORS. 


As  has  been  announced,  Thomas  Fell,  LL.D., 
D.C.L.,  president  of  St.  John's  College,  has  been 
elected  Provost  of  the  University  under  salary 
and  with  executive  functions.  This  is  an  im- 
portant step  in  the  history  of  this  institution,  as 
the  Provosts  hitherto  have  been  unsalaried  offi- 
cers, whose  duties  have  been  nominal  rather  than 
actual.  Those  who  have  occupied  this  position 
in  the  past  have  been  men  of  the  highest  stand- 
ing in  the  State  and  nation.  Hon.  Robert  Smith, 
Secretary  of  the  Navy.  Attorney-General  and 
Secretary  of  State,  respectively,  was  the  first 
Provost,  serving  from  1813-1815.  He  was  suc- 
ceeded by  Right  Rev.  James  Kemp,  D.D.,  S.T.D., 
Episcopal  Bishop  of  Maryland,  who  served  from 
1815-1826.  The  Hon.  Roger  B.  Taney,  LL.D.. 
Chief  Justice  of  the  Supreme  Court  of  the  United 
States,  was  Provost  from  1826-1839.  Dr.  Ashton 
Alexander,  a  prominent  physician  of  Baltimore, 
was  Provost  from  1830-1850.  He  was  followed 
by  Hon.  John  P.  Kennedy.  LL.D.,  Secretary  of 
the  Navy  in  1852,  soldier,  lawyer,  statesman  and 
scholar,  who  served  as  Provost  from  1850- 1870. 
LTpon  his  death  Hon.  Severn  Teackle  Wallis, 
LL.D.,  a  distinguished  lawyer,  eminent  citizen 
and  gifted  orator,  was  elected  to  the  vacant  chair, 
which  he  filled  until  his  death  in  1894.  Air.  Wal- 
lis is  well  remembered  by  graduates  of  the  Uni- 
versity between  1870-1S94,  as  most  of  them  re- 
ceived their  diplomas  from  his  hand.  The  next 
incumbent  was  Bernard  Carter,  LL.D.,  formerly 
a  professor  in  the  Law  School,  and  recognized  as 


the    leading    lawyer    of   the    State.      Mr.    Carter 
served  from  1894  to  his  death  in  10,12. 

The  times  have  changed,  and  it  has  becore 
necessary  that  we  should  change  with  them.  An 
active  head  of  the  University  has  become  a  neces- 
sity, and  Dr.  Fell,  the  eighth  in  lineal  succession, 
is  the  first  to  assume  actual  executive  functions. 
Let  us  all,  therefore,  uphold  his  hands  in  every 
effort  for  the  good  of  the  University. 


THE  PATHOLOGICAL  ENDOWMENT 
FUND. 


The  pathological  endowment  fund  is  not  in- 
creasing a;  rapidly  as  is  desirable ;  fortunately  in 
one  way  (  r  another  it  does  grow.  Our  efforts 
have  been  somewhat  relaxed  recently ;  we  must 
brace  up  and  go  at  it  again. 

Don't  be  backward,  boys !  Step  up  to  the  cap- 
tain's office  and  pass  over  the  coin!  If  you  can't 
give  much,  give  what  you  can ! 

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NEW   SUBSCRIPTIONS    IN    JANUARY,    I913. 

M.  C.  Freilinger,  1906 $10  00 

W.  C.  Gordon,  1907 10  00 

Total $20  00 


THE  NEW  RATING  OF  THE  MEDICAL 
SCHOOLS. 


The  Council  on  Medical  Education  of  the 
American  Medical  Association  has  published  its 
estimate  of  the  standing  of  the  various  medical 
colleges  of  this  country.  We  are  pleased  to  an- 
nounce that  after  a  careful  inspection  by  a  joint 
committee  of  three,  from  the  Council  on  Medical 
Education  and  the  Association  of  American  Medi- 
cal Colleges,  we  have  been  placed  in  Class  A. 

The  task  of  elevating  the  standard  of  medical 
education  and  of  crushing  out  the  unfit  schools 
goes  on  relentlessly.  By  merger  and  dissolution 
the  number  of  medical  schools  has  been  reduced 
from  160  in  1904  to  1 16  in  1912,  and  several  other 
mergers  and  closures  are  announced  as  likely  to 
occur  in  the  near  future. 

Such  agencies  as  the  New  York  Board  of  Edu- 
cation, the  Council  on  Medical  Education,  the 
Association  of  American  Medical  Colleges  and 
the  various  State  Examining  Boards  are  exerting 
a  powerful  influence,  both  potential  and  moral,  on 
medical  education,  and  those  schools  that  cannot 
or  will  not  come  up  to  modern  requirements  will 
be  forced  to  close  their  doors. 

The  fact  that  we  are  in  Class  A  does  not  mean 
that  we  can  rest  satisfied  with  our  present  condi- 
tion, hut  in  every  way  we  must  continue  to  ad- 
vance. It  will  be  one  of  the  first  duties  of  the 
new  Provost  to  trv  to  raise  funds  for  the  endow- 


ment of  the  medical  department.  Without  en- 
dowment the  modern  medical  school  cannot  exist 
much  longer.  We  need  $500,000  to  put  us  thor- 
oughly on  our  feet.     Who  will  help  us  to  get  it? 


ITEMS 

Dr.  James  D.  Love,  class  of  1897,  501  Laura 
street,  Jacksonville,  Fla.,  announces  to  his  pa- 
tients and  his  friends  in  the  medical  profession 
that  his  practice  is  now  limited  to  the  diseases 
of  children. 


Dr.  Joseph  Firey,  class  of  1910,  is  located  at 
the  Medical  Building.  Portland,  Ore. 


Dr.  William  C.  Terry,  class  of  1912,  of  Ham- 
let, N.  C,  writes  us  as  follows: 

"I  am  very  much  interested  in  the  University 
and  its  alumni,  and  want  to  keep  in  touch  with 
the  happenings  of  the  old  University." 

Dr.  Terry  is  building  up  a  fine  practice,  and 
was  recently  appointed  assistant  surgeon  to  the 
Seaboard  Air  Line,  local  division.  1  lamlet  is  a 
new  and  growing  town  of  3500. 


Dr.  Moses  J.  Fine,  class  of  1910,  surgeon  of 
the  Steamer  Yultunro  of  the  Uranium  Line,  can 
be  reached  at  1893  Bergen  street,  Brooklyn,  N.  Y. 
Dr.  Fine  spent  his  honeymoon  in  Norfolk,  OH 
Point,  Washington  and  Baltimore.  While  in  Bal- 
timore Dr.  Fine  dropped  in  the  hospital  to  greet 
his  old  acquaintances. 


Dr.  Henry  Frederick  Vinup,  class  of  upg, 
1 22 1  Hollins  street,  has  been  appointed  assistant 
surgeon  of  the  Fourth  Regiment,  Maryland  Na- 
tional Guard,  to  succeed  Dr.  J.  Harry  Ullrich. 
Dr.  Vinup  is  health  warden  for  the  Eighteenth 
Ward.  He  reported  promptly  at  the  armory  and 
vaccinated  the  officers  and  men  of  Major  Albert 
S.  Gill's  battalion. 


■Dr.    Louis    Mines    Allen   of   Winchester,    Ya., 
was  a  recent  visitor  to  the  University  Hospital. 


Dr.  A.  D.  McConachie,  class  of  1890,  who  was 
chief  surgeon  of  the  Maryland  National  Guard 
during  the  administration  of  the  late  Governor 
Crothers,  is  being  mentioned  for  a  position  as 
assistant  surgeon  in  the  Fourth  Regiment  to  suc- 
ceed Dr.  E.  A.  Smith.     Dr.   .McConachie  was  a 


THE    HOSPITAL   BULLETIN 


231 


brigadier-genera]  on  the  staff  of  the  late  ( iovernor 
t  rothers. 


Dr.  Rupert  Blue,  class  of  1892,  Surgeon-Gen- 
eral U.  S.  P.  II.  S.,  and  well  known  for  his  work 
in  eliminating  plague  from  western  coast  cities 
Of  America,  will  deliver  lectures  at  the  Univer- 
sity on  tropical  diseases.  <  Hhers  who  will  lec- 
ture during  this  course  are  Dr.  Henry  R.  Carter, 
class  of  1879,  Surgeon  U.  S.  P.  H.  S.,  the  yellow- 
fever  expert :  Dr.  Charles  Wardell  Stiles,  and  Dr. 
James  Archibald  Nydegger,  class  of  1892,  Sur- 
geon l\  S.  P.  H.  S.  Dates  for  these  lectures  will 
be  anni  nmced  later. 

Dr.  Henry  R.  Carter  is  a  native  of  Virginia, 
studied  at  the  Universities  of  Virginia  and  Mary- 
land, and  entered  the  (then)  Marine  Hospital 
Service  the  year  of  his  graduation,  1 8~<j.  His 
service  has  been  almost  entirely  in  sanitary  work, 
especially  in  connection  with  yellow  fever.  Dur- 
ing- the  yellow-fever  epidemics  of  1893,  1897, 
1898  and  i8<;<)  Dr.  Carter  did  yeoman  service. 
In  McHenry,  Miss.,  in  1898,  an  epidemic  of  yel- 
li  i\v  fever  was  suppressed  for  the  first  time  in  the 
history  of  the  world,  once  the  disease  had  gained 
headway.  Dr.  Carter's  work  in  this  instance  has 
been  copied  with  success  in  recent  epidemics.  In 
iqio  the  University  conferred  upon  Dr.  Carter 
the  honorary  degree  of  doctor  of  laws.  Dr.  Car- 
ter is  now  stationed  at  the  Marine  Hospital  at 
Baltimore,  and  we  are  very  glad  the  students  are 
given  this  opportunity  to  hear  him. 

Dr.  Rupert  Blue  was  born  in  South  Carolina 
in  t868.  He  was  graduated  from  the  University 
of  Maryland  in  1802.  and  became  an  interne  in 
the  Marine  Hospital  Service  during  the  same 
year.  The  following  year  he  was  commissioned 
Assistant  Surgeon,  and  promoted  to  the  grade  of 
Past  -Assistant  Surgeon  in  1897  and  Surgeon  in 
1909.  He  was  commissioned  Surgeon-General  of 
the  Public  Health  and  Marine  Hospital  Service 
January  13,  K;i2,  which  appointment  was  won 
by  noteworthy  and  meritorious  service,  especially 
evidenced  in  the  suppression  and  eradication  of 
bubonic  plague  in  San  Francisco  in  10.07,  which 
work  brought  him  instantly  into  such  prominence 
that  his  fitness  for  the  position  of  Surgeon-Gen- 
eral could  not  but  be  recognized.  Dr.  Blue  re- 
cently spent  some  time  in  Europe  studying  pre- 
ventive medicine  as  practiced  there,  and  in  1910 
graduated  from  the  London  School  of  Tropical 
Medicine.     In  Mav  of  the  same  vear  he  was  de- 


tailed to  represent  the  Public  Health  and  Marine 
Hospital  Service  at  the  International  Congress 
on  Medicine  and  Hygiene  at  Buenos  Ayres,  and 
while  there  took  advantage  of  the  opportunity 
to  study  possible  routes  by  which  plague  and 
yellow  fever  might  be  brought  into  the  United 
States  from  South  America.  His  last  detail  be- 
fore his  appointment  as  Surgeon-General  was  at 
Honolulu  to  act  in  an  advisory  capacity  to  the 
1  [awaiian  Hoard  of  Health  and  other  departments 
of  the  Territorial  Government  to  inaugurate  a 
program  to  reduce  to  a  minimum  the  introduction 
and  spread  of  yellow  fever  or  plague  in  the  Ter- 
ritory after  the  opening  of  the  Panama  Canal. 
The  students  of  the  University  will  recall  1  )r. 
Blue  at  the  time  that  the  honorary  degree  of 
doctor  of  science  was  conferred  upon  him  in  1909 
by  his  alma  mater. 

Dr.  Stiles  is  a  graduate  of  the  I "niversitv  of 
Leipzig,  class  of  1890.  and  the  University  of 
Paris,  class  of  1896.  He  has  done  much  work  in 
the  investigation  of  the  hookworm  disease  in 
North  Carolina,  and  will  talk  to  the  students 
along  that  line. 

Dr.  Nvdegger  entered  the  Marine  Hospital 
Service  July  1,  1892,  and  was  commissioned  a 
Surgeon  February  4,   1899. 


Dr.  Eugene  B.  Howie,  class  of  19 10,  is  located 
at  1 23V2  Fayetteville  street,  Raleigh,  N.  C. 


Dr.  William  Culbert  Lyon,  class  of  1907,  has 
been  commissioned  an  assistant  surgeon  in  the 
Medical  Reserve  Corps,  United  States  Army. 


There  will  be  three  more  meetings  of  the  Uni- 
versity of  Marvland  Medical  Societv  this  season. 


Dr.  Isaac  Cockey  Dickson,  class  of  1897,  who 
has  been  very  ill  with  peritonitis,  has  recovered 
sufficiently  to  resume  his  practice. 


Dr.  Frank  Paul  Firey.  class  of  i<)io,  is  located 
at  Northwest  Building,  Portland,  <  )re. 


Dr.  Nathan  Ryno  Gorter.  class  of  1879.  I  W. 
Biddle  street,  has  recently  been  appointed  Health 
Commissioner  of  Baltimore  to  succeed  the  late 
Dr.  James  Boslev.     Dr.  Gorter  was  born  in  Bal- 


232 


THE    HOSPITAL    BULLETIN 


timore  county,  Maryland,  April  25,  i860.  1  le 
is  the  son  of  Gosse  Onno  and  Mary  Ann  Polk 
Gorter,  and  on  his  father's  side  is  a  descendant 
of  Dutch  ancestors,  and  on  his  mother's  side 
of  an  old  Maryland  Scotch-Irish  family.  He 
was  educated  in  Anne  Arundel  County  Academy 
and  at  the  University  of  Maryland.  Since  his 
graduation  Dr.  Gorter  has  practiced  in  Balti- 
more, and.  while  his  practice  has  been  general, 
he  inclines  strongly  to  surgery,  in  which  branch 
he  has  gained  an  excellent  reputation,  and  is  one 
of  the  best-known  physicians  in  the  city.  Dr. 
Gorter  is  a  brother  of  Judge  James  P.  Gorter  of 
the  Supreme  Bench  of  Baltimore  City.  The 
late  "Al"  Gorter  was  another  brother.  Thirteen 
years  ago  he  married  Miss  Mary  Gordon  Xorris 
of  Baltimore. 

It  is  not  expected  that  Dr.  Gorter  will  make 
any  changes  in  the  department.  Dr.  William 
Royal  Stokes  has  served  as  bacteriologist  for 
main'  years. 


Dr.  Roscoe  C.  Carnall,  class  of  1905.  is  located 
at  Ballsville.  \  a. 


Dr.  John  Samuel  Fulton,  class  of  1881,  22  it 
St.  Paul  street,  has  been  appointed  secretary  to 
the  State  Board  of  Health  to  succeed  Dr.  Mar- 
shall L.  Price,  who  recently  resigned.  In  accept- 
ing this  office,  which  pays  S2500  a  year,  Dr. 
Fulton  gave  up  a  $5000  place  in  Washington. 
The  members  of  the  State  Board  are  highly  elated 
over  Dr.  Fulton's  acceptance,  and  believe  with 
him  as  the  guiding  head  of  the  department  it  will 
embark  upon  an  exceptionally  bright  future. 
The  Evening  Sun  had  the  following  to  say  upon 
his  selection  : 

"The  State  Board  of  Health  has  made  an  ex- 
cellent choice  in  selecting  Dr.  John  S.  Fulton  as 
secretary,  add  the  public  is  to  be  congratulated 
on  his  acceptance.  X'early  the  whole  of  Dr.  Ful- 
ton's professional  life  has  been  devoted  to  the 
study  of  questions  connected  with  public  hygiene. 
and  he  brings  to  his  work  not  only  expert  knowl- 
edge and  training,  hut  genuine  personal  enthus- 
iasm for  its  duties.  Such  a  position  requires 
sound  judgment  as  well  as  special  equipment, 
and  Dr.  Fulton's  record  appears  to  show  that  he 
possesses  this  happy  and  necessary  combination 
of  practical  sense  and   scientific  attainment." 


In  accepting  such  a  position.  Dr.  Fulton  sim- 
ply comes  home  again,  as  he  is  distinctly  a  Marx- 
lander.  He  was  educated  in  this  State,  gradu- 
ated from  her  oldest  medical  institution,  served 
her  many  years  as  a  private  practioner  in  the 
counties,  and  then  in  Baltimore,  and  was  from 
1896  to  \<)0/  secretary  to  the  State  Board  of 
Health,  and  therefore  well  acquainted  with  the 
work  to  which  he  is  returning.  He  was  for  sev- 
eral years  editor  of  the  Maryland  Medical  Jour- 
nal, and  afterwards  became  secretary-general  of 
the  International  Congress  of  Tuberculosis;  and 
with  the  unusual  combination  of  a  personal 
knowledge  of  county  and  city  practice  and  State 
and  National  and  international  public  health  work 
comes  to  the  work  he  resigned  in  IQ07  better 
equipped  for  it,  possibly,  than  any  other  health 
board  secretary  in  the  country,  and  The  Bulle- 
tin joins  with  the  Evening  Sun  in  congratulat- 
ing the  public  upon  Dr.  Fulton's  acceptance. 

Dr.  Fulton  was  born  in  1859,  at  Fremont,  (  >., 
oldest  son  of  Rev.  William  Fulton,  D.D..  of  Glas- 
gow, Scotland,  and  Nancy  <  )rgan  Fulton  of 
Cable,  O.  He  came  to  Maryland  in  [863  when 
his  father  became  rector  of  All  Hallows  Parish, 
Snow  Hill,  Md.,  in  1869.  He  entered  St.  John  s 
College,  Annapolis,  in  1872,  graduating  in  1870: 
then  entered  the  office  of  Stephen  P.  Dennis. 
M.D..  Salisbury,  as  a  student  of  medicine,  and 
taught  in  the  public  schools  for  two  vears.  He 
graduated  in  medicine  at  the  University  of  Mary- 
land in  1881.  In  1888  Dr.  Fulton  married  Nancy 
Helen  White  of  Salisbury.  Md. 


Dr.   Alvin   Clay   McCall,  class  of   1910,   is   lo- 
cated at  Rocky  Mount,  X.  C. 


Mrs.  Ethel  Palmer  Clark,  superintendent  of 
the  University  Hospital  Training  School  for 
Xurses.  and  a  graduate  of  the  class  of  1906,  was 
recently  elected  president  of  the  Maryland  State 
Association  of  Xurses. 


Dr.  Alexander  Ross  Mackenzie,  class  of  1910, 
is  located  at  Pevtonia.  W.  Va. 


At  the  recent  meeting  of  the  Alunuue  Associa- 
tion of  the  University  Hospital  Training  School 


THE    HOSPITAL    BULLETIN  233 

for  Nurses  the  following  officers  were  elected  to  <  )scar  YV.  Fletcher,  Sanford,  Accomac  county, 

serve  for  the  coming  year:  Virginia. 

I 'resident— .Miss  Clara  E.  Query,  class  of  1005.  David  Franklin,  122  W.  Lee  street.  Baltimore. 

First  Vice-President— Miss  -Mary  Gavin,  class  George  W.  Hafele,  died  May  3,  1911. 

of  1008.  William  1).  Hammond,  Hagerstown,  Md. 

Second  Vice-President— Mrs.  Page  Edmunds.  Emil  Heller  Henning,  2000  Hollins  street.  Bal- 

formerly  Miss  Millicent  Geare,  class  of  1905.  timore,  Md. 

Secretary — Miss  Jane  R.  Garner,  class  of  1911.  David  Ernest  Hoag, . 

Treasurer — Mrs.    Nathan    Winslow,    formerly  J.  Howard  Hodges.  Harper's  Ferry,  Aid. 

Miss  Margaret  K.  Massey,  class  of  1903.  William    Murray    Hollyday,    330    X.    Charles 

Executive  Committee — Miss  M.  E.  Rolph,  class  street,  Baltimore,  Aid. 

of  1895;  Mrs.  Frank  Lynn,  formerly  Miss  Clyde  J.  Knox  lnsley,  2938  E.  Baltimore  street,  Bal- 

C.   Dawson,   class   of    1908;    Miss    S.    A.    How-  timore,  Md. 

strawer,  class  of   1908.  and  Mrs.  Ethel   Palmer  Joseph  Connor  Joyce,  Arnold,  Md. 

Clark,  class  of  1 9od.  John     Daniel     Kerr,    Jr.,     Clinton,     Sampson 

county,  North  Carolina. 

_,                              . ,.  .    .,      ,  ..             ..        -    ,  Lawrence   Kolb,  Assistant  Surgeon,  U.   S.   P. 

Bv  request,  we  publish  the  following  list  ot  the  _                                                        - 

,-'„',.               ,_  .       ..               ,  H.  S..  Reedy  Island,  Port  Penn,  Del. 

class  of  1908,  with  their  present  locations,  so  tar  J 

,.  ,  Louis   Charles  LaBarre,  024  Hamilton   street, 

as  we  are  able  to  ascertain :  <  ?  t 

/"i      1        ni     1         \     1               r-           i-     1     •  i  Allentown,  Pa. 
Charles    Rhodes    Anderson,    Care,     rredenck 

.      ,-•     ■   •  Paul  P.  Lane,  Wavcross,  W'are  countv,  Geor- 

county,   \  lrgima.  '         -           '                        • ' 

James  Leland  Anderson,  Alain  street.  Green-  &la" 

ville    S   C  Charles    Evans    AIcBrayer,    First    Lieutenant, 

James  Hugh  Bay,  Havre  tie  Grace,  Aid.  Medical  Corps,  U.  S.  A.,  Fort  Howard,  Aid. 

Joseph  Francis  Barry, .  John  J-  McGarrell,  . 

Thomas    Alalcolm   Bizzell,    Goldsboro,   Wayne  Allen     McLean,     Wagram,     Scotland     county, 

county.  North  Carolina.  North  Carolina. 

Grover  Cleveland  Bolin,   Neeses,  Orangeburg  John  Evans  Mackall,  died  April  4,  1912. 

county,  South  Carolina.  Joaquin    S.    A'liranda   y   Castillo,    Cuba,   West 

Alorris    Ramsay    Bowie,    Somerset,    Gunnison  Indies, 

countv,  Colorado.  P.lias  Xathanson,  Summer  street,  Lynn,  Alassa- 

William    Underdown    Charlton,    1803    S.    15th  chusetts. 

street,  Philadelphia,  Pa.  Yerlin   Xolt,   Columbia  City,   Whitley  county. 

Solomon  L.  Cherry,  1605  N.  5th  street,  Phila-  Indiana, 

delphia,  Pa.  Lester  Dimmitt  Norris,  3d  street  and  Central 

William  Joseph  Coleman,  University  Hospital,  avenue,  Cincinnati,  O. 

Baltimore,  Aid.  Frederick    James    Pate,    Pembroke,    Robeson 

Piatt    Walker    Covington,   .       (  Last    at  county,  North  Carolina. 

Rockingham,  N.  C.)  Roy  Clifford  Potter,  . 

Frank  Garnett  Cowherd,  Rockhill,  York  county,  Jaroslav  Radda,  230  E.  /2d  street.  New  York 

South  Carolina.  City. 

James  .Alexander  Craig,  C»  1  3  Jefferson  street,  Russell    Wesley    Raynor,    Vienna.    Dorchester 

Gary.  Ind.  county,  Maryland. 

W.    Cole    Davis.    First    Lieutenant,    Aledical  David    Samuel    Rhone,    447    Kaighn    avenue. 

Corps,  U.  S.  A.,  now  stationed  at  Manila,  P.  I.  Camden,  X.  J. 

( i.  L.  Dougherty,  1901  Delaware  avenue,  Wil-  <  Iranville    Hampton    Richards.    Port    Deposit, 

mington,  Del.  Maryland. 

Slocomb  Rupert  Edwards.  Siler  City,  Chatham  Luther     Allen     Riser,     Leesville.     Lexington 

county,  Xorth  Carolina.  county.  South  Carolina. 

William    A.    Ellingwood,    Winterport,    Waldo  Ramon  Luis  Rodriguez,  San  German,  Alaya- 

county,  Alaine.  guez  county.  Porto  Rico. 


-34 


THE   HOSPITAL   BULLETIN 


Herbert  Jerome  Rosenberg,  Grant  Building, 
Atlanta,  Ga. 

Adin  Adam  Rncker,  Rntberfordton,  Ruther- 
ford  county,  Xorth  Carolina. 

Louis  Hamilton  Setb,  McDaniel,  Mil. 

Leo  George  Scheuricb,  Tomah,  Monroe  county, 
Wisconsin. 

Amzi  Bedell  Sboemaker,  North  Attleboro, 
Bristol  county,  Massachusetts. 

Henry  Lyon  Sinskey,  1610  E.  Baltimore  street, 
Baltimore,  Md. 

Frederick  Snyder.  691  Broadway.  Kingston. 
Ulster  county,  New  York. 

Arthur  <  Igburn  Spoon,  Revolution  Mills, 
Greensboro,  N.  C. 

Leo  Fleischer  Steindler,  1203  W.  Xorth  ave- 
nue, Baltimore,  Md. 

D.  Hoster  Swengel,  Mt.  Carmel.  Abbeville, 
South  Carolina. 

James  Thomas  Taylor,  Madison,  Rockingham 
county,  Xorth  Carolina. 

Horace  B.  Titlow,  3035  O'Donnell  street,  Bal- 
timore, Md. 

Homer  Ulric  Todd,  J^j  X.  Fulton  avenue,  Bal- 
timore, Md. 

Charles  Manly  Walters,  Union  Ridge.  Ala- 
mance county,  Xorth  Carolina. 

Frederick  Chauncey  Warring.  1803  St.  Paul 
street,  Baltimore,  Md. 

Henry  1  Iarry  Weinberger,  724  W.  Fayette 
street,  Baltimore  Md. 

T.  Marshall  West,  Fayetteville.  N.  C. 

Edgar  Harold  Willard,  Mount  Pleasant,   Md. 

Philip  R.  Williams, . 

Franklin  Davis  Wilson,  South  Xorfolk,  A  "a. 

Cato  Franklin  Winslow,  dead. 

Arthur  Leon  Wright,  2105  W.  Pratt  street, 
Baltimore.  Md. 

Arturo  Xelava.  Xicaragua. 

John  Edward  P.erridge  Ziegler,  Hayward,  Wis. 

We  should  be  very  glad  if  any  of  our  sub- 
scribers would  till  in  the  missing  addresses. 


tra  of  the   Medical  and  Chirurgical   Faculty  of 

Maryland  : 

Violins — Drs.  Moses  J.  Lichtenberg,  class  of 
1912;  Harry  L.  Whittle,  class  of  1903,  and  Leo 
John  Goldbach,  class  of  1905. 

Trombone — Dr.  Harry  Stoner,  class  of  1907. 

This  is  the  first  physicians'  orchestra  organized 
in  the  United  States,  though  there  is  one  in  Ber- 
lin and  another  in  Vienna. 


Dr.  Andres  Martin  G.  de  Peralta,  class  of  1912, 
is  located  at  Palma  Soriano,  Oriente,  Cuba,  where 
he  is  doing  general  medical  and  surgical  work. 


Dr.  Enrique  Llamas  is  located  at  145  N.  18th 
street.  Philadelphia,  Pa.,  where  he  is  visiting  dis- 
pensary physician  to  the  eye  department  of  Will's 
Eye  Hospital. 


Among  the  University  alumni  practicing  in 
Kansas  are : 

Bolton — Christopher  Brenner,  class  of  1906. 

Fort  Leavenworth — Wm.  X.  Bispham,  class  of 
1897,  Major  M.  C,  U.  S.  A.,  Military  Prison. 

Fort  Scott — Robert  John  Whitfield,  class  of 
1893,  Masonic  Temple. 

Hays — Jos.  H.  Middlekauff,  class  of  1879. 

Salina — Melcher  Gist  Cockey,  class  of  1870. 

Wakefield — Charles  Hewitt,  class  of  1868. 


UNDERGRADUATE  NOTES 


Under  the  Supervision  of  E.  Kilboitrn  Tullidge. 


Messrs.  Franklin  D.  Murphy  and  Frederick  L. 
McDaniel.  members  of  the  senior  class,  took  the 
United  States  Civil  Service  Examinations  on 
Wednesday,  February  5.  1913,  for  positions  of 
physicians  (male)  in  the  Indian  service. 


Dr.  ( ierardo  Vega  y  Thomas,  class  of  1912,  is 
at  present  assisting  Professor  Fortun,  one  of 
Havana's  oldest  and  best-known  surgeons,  and 
is  located  at  Espada  No.  134,  Havana,  Cuba. 


The    following    alumni    of    the    University    of 
Maryland  are  members  of  the  physicians'  orches- 


President  Xorbert  C.  Nitsch  of  the  senior  class 
has  been  confined  to  his  home  during  the  past 
week  bv  a  severe  attack  of  influenza. 


The  annual  dance  of  the  clinical  assistants  was 
held  Friday  evening.  January  17,  1913,  at  Al- 
baugh's  Parlors.  The  patronesses  were  Mesdames 
Randolph  Winslow.  S.  E.  Xeale.  Arthur  M.  Ship- 


THE   HOSPITAL   BULLETIN 


235 


ley.  Gordon  Wilson,  Hiram  Woods,  John  W. 
Holland,  Nathan  Winslow  and  R.  H.  Johnston. 
The  affair  was  a  decided  success,  there  being 
plenty  to  eat,  good  music,  and  lots  of  pretty  girls. 


The  Delta  Chapter  of  Kappa  l'si  Fraternity 
is  preparing  to  hold  its  annual  dance  at  Schman's 
Hall  on  the  evening  of  February  17,  1913. 


A  successful  dance  was  given  by  the  Nu  Sigma 
Nu  Fraternity  at  Albaugh's  Parlors  Friday  even- 
ing. January  3] .  1913. 


A  delightful  theater  party  was  given  by  the 
Phi  Sigma  Kappa  Fraternity  Friday  evening, 
February  7,  1913,  to  see  Daniel  D.  Carter's  latest 
play.  "The  Master  Mind." 


The  following-  invitation  has  been  received  by 
the  Kapp.  Psi  Fraternity: 

The  President  and  Directors 

of 

The   Panama-Pacific  Universal  Exposition7 

to  be  held  in  San  Francisco  in   1915 

have  the  honor  to  extend  to 

KAPPA    PSI    FRATERNITY 

A  cordial  invitation  to  hold  its  1915  meeting  in 

San  Francisco. 

This  city  has  been  selected  by  Congress,  with 
the  approval  of  the  President  of  the  United 
States,  as  the  official  site  for  celebrating  the  unit- 
ing of  the  waters  of  the  Pacific  and  Atlantic 
through  the  Panama  Canal,  the  greatest  physical 
accomplishment  achieved  by  man.  The  Exposi- 
tion will  not  only  attempt  to  show  that  which  is 
most  advanced  in  Invention,  most  interesting  in 
Art  and  of  greatest  scientific  value,  embracing 
all  that  is  most  important  in  the  material  progress 
of  the  world,  but  it  will  be  the  aim  of  the  directors 
to  make  it  rank  in  intellectual  interest  above  all 
previous  expositions ;  to  bring  together  so  much 
of  wisdom,  so  much  of  practical  scientific 
thought  and  so  much  of  broad  grasp  of  the 
world's  important  problems  that  the  progress 
of  mankind  shall  be  advanced  a  quarter  of  a  cen- 
tury. 

I"  assist  in  achieving  this  aim.  we  invite  your 


presence  in  the  city  of  San  Francisco  in  the  year 
Nineteen  Hundred  and  Fifteen. 

Bent.  I.  Wheeler, 
President,  University  of  California. 
David  Starr  Jorden, 
President.  Leland  Stanford  University. 
Rudolph  J.  Tanssig, 
Chairman,  Committee  on  Exposition, 
Wm.  Brisbane  Walker, 

Director  of  Congresses. 
Chas.  I.  Moore, 

President. 
F.  S.  Stiffe, 
Dircctor-in-Chicf  of  Foreign   and  Domestic 
Participation. 

[seal.] 


An  examination  in  major  surgery  was  given 
in  Davidge  Hall  by  Prof.  Randolph  Winslow  to 
the  members  of  the  senior  class  on  Tuesday,  Feb- 
ruary 4,  1913. 


Prof.  Hiram  Woods  has  announced  that  he 
will  hold  his  final  examination  on  the  eye  for  the 
senior  class  earlv  in  February. 


William  Frank  McDaniel  of  the  freshman 
medical  class,  who  has  been  confined  to  the  hos- 
pital with  an  attack  of  chronic  appendicitis,  has 
recovered. 


At  the  State  Board  examinations,  held  in 
Man-land  recently,  two  members  of  the  senior 
class  made  exceptionally  good  showings — Leon- 
ard Hays  received  a  general  average  of  85  per 
cent,  and  Ross  B.  Kolb  an  average  of  82  per  cent. 


Examinations  for  entrance  to  Bayview  Hos- 
pital were  held  on  Tuesday,  February  7.  1913. 
The  subjects  were  medicine,  surgery  and  clinical 
pathology. 


On  Wednesday,  February  5,  Dr.  C.  W.  Stiles, 
U.  S.  P.  H.  S.,  gave  an  illustrated  lantern  lecture 
in  Chemical  Hall  on  the  "Hookworm." 


Other  weekly  lectures  on  Tropical  Medicine  by 
members  of  the  U.  S.  Public  Health  Service  have 
been  arranged  by  Professor  Zueblin,  to  be  held  in 
Anatomical  Hall  on  Tuesday  of  each  week  at  2 
o'clock  P.  M. 


236 


THE    HOSPITAL    BULLETIN 


Students  desirous  of  taking  the  Pennsylvania 
State  Board  Examination  in  June  will  be  required 
to  show  evidence  of  having  delivered  six  obstet- 
rical cases,  assisted  in  six  surgical  operations,  ad- 
ministered six  anesthetics  and  witnessed  six 
autopsies. 


The  first  of  a  series  of  interesting  and  instruct- 
ive clinics  conducted  by  Prof.  Irving  J.  Spear  on 
mental  diseases  at  Bayview  Hospital  was  held 
on  Saturday,  February  i,  1913,  the  subject  being 
stigmata,  degeneration,  imbecility  and  idiocy. 
Professor  Spear  has  announced  his  remaining 
clinics  to  be  as  follows :  Dementia  precox,  para- 
noia, February  15;  general  paresis,  March  1  ;  se- 
nilitv  and  organic  dementia,  March  8;  psychosis 
due  to  intoxication,  March  5  ;  maniacal  and  de- 
pressive  insanity. 


Prof.  L.  E.  Xeale  desires  to  announce  through 
The  Bulletin  that  he  will  welcome  all  candi- 
dates of  the  senior  class  desiring  interneship  in 
the  obstetrical  department  of  the  hospital  at, his 
home,  io5  E.  Read  street. 


A  communication  from  Dr.  N.  Travis  Gibbs  of 
42  W.  75th  street,  New  York,  states  that  there 
are  several  vacancies  at  Blackwell's  Island,  and 
requests  those  desiring  interneship  there  to  com- 
municate with  him  at  their  earliest  convenience. 


The  price  of  Terra  Mariae  will  be  $2.50  if  a 
deposit  of  $1  is  made  with  Editor-in-Chief  Breed- 
ing before  March  1,  otherwise  $3  per  copy  will  be 
charged. 


MARRIAGES 


Dr.  James  Erwin  Diehl,  class  of  19]  i,  was  mar- 
ried on  Saturday  morning,  Jenuarv  18,  1913.  at 
11.30  o'clock,  in  Raleigh,  N.  C,  to  Miss  Lillie 
May,  daughter  of  Mrs.  Mary  Eleanor  Tucker  of 
Raleigh,  X.  C.  Dr.  and  Mrs.  Diehl  will  be  at 
home  after  February  i  at  the  Trenton  State  I  [os- 
pital. 


Dr.  William  Herbert  Pearce,  class  of  iS«)i,  of 
2105  X.  Charles  street.  P>altimore,  was  married 
on  Tuesday,  February  4.  1913,  to  Miss  Sarah 
Frances  Ferguson,  daughter  of  Mrs.  Hugh  Fer- 


guson, of  Charleston,  S.  C.  The  couple  were 
married  at  the  home  of  the  bride.  21  George 
street.  The  ceremony  was  performed  by  Rev. 
Dr.  Duffy  Fill,  and  was  witnessed  by  members 
of  the  two  families  only.  Dr.  ami  Mrs.  I'earce 
will  be  at  home  after  February  to  at  2105  N. 
Charles  street. 


DEATHS 

Dr.  Robert  John  Price,  class  of  i8o(>.  died  at 
his  home  411  Vienna,  Aid.,  January  15,  i  < » 1 3 ,  of 
paralvsis,  aged  "/$  years.  Dr.  Price  was  born  in 
Centreville,  Md.,  October  13,  1838.  He  was  the 
son  of  John  C.  and  Elizabeth  Downing  Price, 
both  natives  of  Maryland  and  descendants  of 
English  ancestors.  He  was  educated  in  the  pub- 
lic schools  of  Baltimore,  Centreville  Academy  and 
the  University  of  Maryland.  He  also  attended 
clinical  lectures  in  the  University  Hospital,  and 
in  the  same  year  in  which  he  graduated  entered 
upon  his  professional  career  at  Vienna.  He  was 
one  of  the  best  known  and  most  popular  physi- 
cians in  Dorchester  county,  and  one  of  the  most 
successful. 

Dr.  Price  was  at  one  time  a  member  of  the 
School  Board,  and  for  many  years  physician  to 
the  almshouse. 

He  was  twice  married,  and  is  survived  by  the 
following  children  by  his  first  wife,  who  was 
Miss  Laura  Jump  of  Queen  Anne  :  Mrs.  Charles 
Uearn,  Mrs.  Jacob  Cook  and  Miss  Emma  Price 
of  Baltimore;  Mrs.  Lloyd  (!.  LeCompte  of 
Vienna  and  Alfred  Price  of  Philadelphia:  and  by 
his  second  marriage,  to  Miss  Emma  Lester  of 
Richmond,  Va.,  by  the  following  three  children: 
Fester.  Benson  and  Richmond  Price. 


Dr.  Edward  Fawrence  Casey,  class  of  1905, 
died  at  his  home  in  North  Woodstock,  X  11  , 
December  to.  1912,  aged  30  years. 


Dr.  George  W.  Davis,  class  of  1869,  died  on 
Sunday,  January  \<>,  [913,  at  his  home  near 
Pleasantville,  Md..  aged  69  years.  Dr.  Davis  had 
been  in  ill-health  for  some  time,  and  his  death 
was  not  unexpected.  lie  is  survived  by  his 
widow,  who  was  Miss  Mary  J.  Beaumont.  Dr. 
Davis  enjoyed  a  large  and  lucrative  practice,  and 
was  much  beloved.  He  was  buried  on  Wednes- 
day, January  22,  at  the  Old  Baptist  Church, 
Jarrettsville,  Md. 


HOSPITAL  BULLETIN 

OF  THE 

UNIVERSITY  OF  MARYLAND 

VOLUME  VIII 

FEBRUARY  15,  1912-FEBRUARY  15,  1913 


CONTRIBUTORS  TO  VOLUME  VIII 


Allgood.  R.  A 65, 

Bickel,  Adolph,  M.D 

Bulluck,  Ernest  S.,  M.D 

( larroll,  Albert  Hynson,  M.D 7. 

]  lanson,  Ejnar,  ALL) 30, 

Hemmeter,  John  C 41. 

]  [innant,  Milford 

Irwin.  Henderson 

Johnston,  Richard  H.,  M.D 

Kloman,  E.  H..  Ph.D.,  M.D 

K<  ihn,  1  -1  mis  Winfield,  M.D 

Kolb,  Edward  P 

Linn.  Willis.  M.D 

Lew  iper,  Edward  A 7, 

McMillan,  Roscoe,  M.D 101, 

Matthews,  A.  Aldridge,  M.D 1,   164, 


AGE 
124 
170 

25 

8i 
192 

51 
4') 

22  I 

105 

21 

7 

47 
204 
206 


PAGE 

Xiblett.  W.  Saulsbury,  M.D 88 

I'earce.  William  Herbert,  M.D 44 

Rauschenbach,  C.  W 10.  28,  105 

Roberts,  Charles  Wesley,  M.D 103 

Schapiro,  A 22J 

Scott,  W.  M 28 

Stewart,    Emmet   James 200. 

Strosnider,  C.  F.,  M.D 31 

Timanus,  George  L 22^ 

Tullidge.  E.  K 4,  208 

Vinciguerra,  Michael 69 

Winslow,  John  R.,  B.A.,  M.D 201 

Winslow.  Xathan,  M.D. .  .67,   108.   128.   1  }o,  140, 
Winslow.  Randolph,  A.M.,  M.D.,  LL.D.  .61, 

6",   121,   141.    l6l     l8l 

Zueblin,  Ernest,  M.D 145,  186 


INDEX  TO   VOLUME  VIII 


PAGE 

Abbitt.  John  Willis 66 

Abbott.  Alexander  C 07 

U>sher,  Darius  C 174 

Abstract 74,  94,  I  [3 

Academic  Day i~(> 

Adams,  J.  Fred 138 

Address  of  Prof.  Adolph  Bickel 170 

Address  to  Seniors  and  Juniors,  Initial 145 

Adjunct  Faculty 56 

A  1  land -nine  Gift n  14 

Aims  of  Clinical  Teaching  in  Medicine 180 

Allen.  Lewis  Mines 158,  230 

Alumni  as  Con  iners !  52 

Alumni  Association 96 

Alumni  Association.  The  Functions  of  an..  44 

Alumni   Athletic  Association 35,  95,  136 

Alumni  Advisory  Council 55 


PAGE 

Alumni  at  Mercy  Hospital 135 

Mercy  Hospital  Dispensary 136 

Skin  and  Cancer  Hospital 117 

State  Sanatorium 135 

City  Health  Department 134 

Alumni  in  Alabama 216 

Arkansas [93 

California 1 77 

G  ilorado [96 

Delaware 1 74 

District  of  Columbia 124 

Florida 157 

( lei  irgia 136 

Idaho 95,  173 

Illinois 158 

Indiana 139 

1 1  >wa 213 


'38 


THE   HOSPITAL   BULLETIN 


PAGE 

Kansas 234 

Kentucky 2  I 3 

Louisiana 213 

Maine 130 

Massachusetts 178 

Faculty  Officers 43 

P.  &  S.  Faculty 135 

Alumni  Banquet  Address 96 

Alumni  Passing  State.  Board 1 18,  216 

Alumni  as  District  Health  Officers 58 

Amebic  Dysentery 101 

American  Medical  Association  and  the  Medi- 
cal Colleges ~i 

American  Surgical  Association 196 

Analytical  Study  of  Fifty  Cases  Treated  in 
the  Gastro-Enterological  Department  of 
the  University — Reviewed  with  Special 
Attention  to  the  Anthropometric  Measure- 
ments         7 

Anatomists  of  the  University  of  Maryland, 

History  of  the 2^ 

Anderton,  Herbert  S 98 

Aneurisms  of  the  Arch  of  the  Aorta  and  of 
the  Innominate  Artery  by  the  Introduc- 
tion of  Foreign  Bodies  Into  the  Sac,  Treat- 
ment of 124 

An  Explanation  and  An  Appeal 33 

An  Explanation 1 1 1 

Anne  Arundel  Count)'  Medical  Association.  .    176 

Arnold,  William  T 38 

Ashby,  Thomas  A 59,   199 

Asper,  Burt  J 1 56 

.Athletic  Association 18 

Athletics 36 

Baldwin,  Thomas  C 220 

Ballenger,  Edgar  G 120 

Barron,  John 1 20 

Baseball  Team 17,  39,     58 

Basket-ball  Team 18,  198,  218 

Battle,  George  C 1 54 

Bay,  James  Hugh 159 

Bay,  Robert  Parke 15.  55,     97 

Beavers,  John  T 217 

Bell,  Alice  Frances 119 

Benzinger.  Joseph  C 80 

Beri-Beri  Clinic 152 

Bevan.  Arthur  D 134,   176 

Bickel,  Adolph  von 1 73 

Bickel,  Prof.  Adolph.  Address  of 170 

Billups,  Gains  \Y 1 19 

Bird,  Jacob  W 70 

Births 19,  38,  79,  150 

Bissell,  J.  Dougal 17 

Bizzell,  Thomas  M 158 

Blair,  John  L 20 

Blalock.  B.  Karl 198 

Blue,  Rupert 231 

Blum,  Joseph 17 

Bone  Fractures,  Some  Points  of  Interest  as 

Regards  Long 164 

Book  Reviews 40,   109,  140,    170 


PAGE 

Borck,  Mathias  A.  R 20 

1  Sowden,  David  T 60 

Bow-Leg — Genu  Varum 227 

Bowman.  Humphrey  E 80 

Howie.  Morris  R 157 

Braithwaite.  Wm.  W 50 

Breast  Affections — A  Series  of  One  Hun- 
dred Cases 67 

Breeding,  Earle  Griffith' 198 

Brewington,  Esther  E 156 

Bromwell,  Josiah  R 79 

Bronchoscopy  for  Multiple  Foreign  Bodies 
I  Almond  Shell  and  Pulp)  in  a  Child  Two 

Years  of  Age 201 

Brooks,  Baird  U 17 

Browne,  Bennett  Bernard 35 

Browne,  William  H 199 

Bulluck,  David  W ^2 

Bulluck,  Ernest  S 98.   158 

Bussey,  Bennett  F 60 

Butler,  James  H 160 

Cancer,  The  Public  Should  Be  Educated  in 
Regard  to,  as  is  Being  Done  in  Tubercu- 
losis          1 

Carman,  Perry 137 

Carnall,  Roscoe  C 232 

Carpenter,  Benjamin  F 136 

Carroll,  Albert  Hynson 103,   137 

Carroll.  John  Joseph 1 19 

Carswell.  Walter  S 137 

Carter.  Bernard,  In  Memoriam 90 

Carter,  Henry  R 217,  235 

Cartilaginous  Tumors  of  the  Larynx 54 

Case  of  Infantile  Paralysis  in  Ancient  Egypt.   192 
Case  of  Six  Months'  Miscarriage  Induced  by 
Measles  and  Complicated  by  Tuberculosis.   105 

Casey.  Edward  Lawrence 236 

Cerebral  Luetic  Endarteritis  with  a  Tempo- 
rary Occlusion  of  a  Lower  Anterior 
Branch  of  the  Middle  Cerebral  Artery. 
Causing  a  Temporary  Anemia  of  Broca's 

Convolution 49 

Certain  Diseases  of  Old  Egypt 212 

Chaney.  T.  Morris.  Jr 97 

Chapman.  Robert  F 17S 

Charles  VV.  Mitchell  Medical  Society 39,   100 

Chisolm.  Archibald  A 95 

Chisolm,   Prof.   Julian   J.,   and   Miss    Helen 

Keller 131 

Chisolm,  Frances  Miles.  .• 35 

Chi  Zeta  Chi 19.  40,     58 

Clark,  Ethel  P 198,  232 

Clarke,  Sydenham  Rush 10 

Class  of  1905 34 

Of  1908 158,  233 

Of  1909 175 

Of  1912 95 

Clinical  Assistants 130 

Clinics  at  the  University  Hospital 19,  194 

Coale,  Mattie  E 75 

Coale,  R.  Dorsey 15 


/ 


THE    HOSPITAL    BULLETIN 


239 


Cockey,  Melchoir  G 

Coleman.  William  J 

Collins,  Joseph 

Combining  the  Medical  Schools  of  Baltimore. 

Commencement.  The  ( )ne  Hundred  and  Fifth 
Annual J  2, 

Correspondence 

Cortial  Degeneration,  Report  of  a  Case  of, 
with  Section  of  Posterior  Spinal  Roots  for 
Relief  of  Symptoms 

Crampton,  Louis  W 

Craven,  William  \Y 

Curry,  W.  C 

Cyclopedia  of  American  Medical  Biography. 

59. 

Davis,  ( ieorge  W 

Davis,  Hoagland  Cook 

Davis,  Judson  J 

1  )awson,  Robert  M 

Dean.  Russell  Hardy,  Jr 136,    137, 

Deaths 19,  38,  60,  75,  79,  120,  139, 

159,    17S,   199,  219, 

DeMarco,  S 

Development  of  Antiseptic  and  Aseptic  Sur- 
gery   

DeVilbiss,  Clifton  N 

Diagnosis  of  Syphilis 

i  lickson,  Isaac  C [38, 

Diehl,  James  E 

Disbrow,  George  W 

Dispensary  Cases 

1  )ispensary  Report  .  .  . .' 

Dobbin,  George  W 35, 

Douglass,  Louis  H 

Dougher,  Thomas  R 

Drop-Finger,  with  Report  of  Case '. 

Dysentery,  Amebic 

Ebert,  J.  William 139, 

Editorials 13,  33,  53,  71.  91,    111, 

'i1-  152,  171.  193.  2I4. 

Edmunds,  Page 

Ellingwood,  William  A 

Ely,  Emily  L 

Emrich,  William 16, 

Engagements 1  . .  .79, 

Ewens,  Arthur  E 

Egypt,  Certain  Diseases  of  Old 

Feddeman,  William  H 

Fell.  Thomas.  A.M.,  Ph.D.,  LL.D..  the  New 
Provost [95, 

Fellers.  William  B 

Field.  John  W 

Field  Meet 

Fine,  Moses  J 219, 

Firey,  Frank  P 

Firey,  Joseph 

First  Aid  to  the  Injured,  with  Special  Ref- 
erence to  Shock 

Fisher,  Charles  T.,  Jr 

Flexner  Report  on  Medical  Schools 

Football  Team 

Fraternities 19, 


'MM'.  PAGE 

1 58      Freshman  Class  Officers 174 

135  Friendly  Controversy  Between  Tw<>  Physiol- 

i)i>  ovists  Concerning  the   Mechanism  of  the 

131  Lesser  Circulation  (Return  of  Blood  from 

the  Gills  to  the  Sinus  Venousus)   in  Flas- 

78         mobranch  Fishes 4: 

99      Full-Time  Teachers 136 

Fulton,  John  Samuel 155,  232 

Functions  of  An  Alumni  Association 44 

28      (  iamble,  Gary  15 138 

60      ( iardiner,  Charles  W 132 

154     <  rarrett,  Robert 138 

12     ( larrison,  ( lertrude  A 98 

( iastric  Ulcer 128 

yj  Gastro-Enterological  Department  of  the  I  ni- 

23G  versity,   Analytical    Study  of   Fifty   Cases 

15  Treated  in  the 7 

6     General  Alumni  Association 176 

160  General    Alumni    Association,    Pennsylvania 

148  Chapter 36 

'  rephart,  Mary  L 98,  109.  158 

235  ( Hbson,  John  S 99 

169      Gichner,  Joseph  E 159 

Giles,  Alfred  B 219 

209      Goettling,  Charles  A 95 

97      Gorter,  Nathan  R 137,  216,  231 

208      Greenway,  ( Gilbert  C 19 

27, 1      Gribble,  Oakey  S 16 

236  ( iriftith,  Ernest  L 95 

218      Grubbs,  Anna  S 16 

80      Guerrant,  E.  Janie 156 

16  Hall,  William  S 79 

135  Hammond,  S.  W 97 

1 19  Hanna,  Michael 66 

19      Harmon,  George  E.  H 19 

130     Harris,  Charles  C 138 

101      Harris,  James  H 13S 

160      Harris,  John  C 178 

I  leffinger,  Clarence  W 139 

221)      Hemmeter,  John  C 35,  $/,   133,   139, 

97  176,   194,  213 

218      Hereditary,  Is  Syphilis 4 

16     Hershner,  Newton  W 99 

117      Hirschman,  Isadore  1 216 

178  History  of  the  Anatomists  of  the  University 

19  of  Maryland 25 

212      Holidays,  The — Giving  and  Receiving 215 

60      Hollingsworth,  Charles  A 135 

Holloway,  Howard  S 151; 

214     1  tollyday,  John  Guy 38 

136  Hopkins,  Ephriam 60,     79 

120  Hopkinson,  Dr.  P>.  Merrill 17 

18      Horn,  August 135 

230  Hospital  Appointments 30 

231  Hotchkiss,  Norton  R 20 

230      House  Dance 218 

1  Ioule,  Eugene  B 231 

204      I  Iubbard.  James  E 120 

198      Hundley,  J.  Mason 198 

133      1  lughes,  J.  A ii7 

177      I  [ussey,  Raymond  G 75 

40    Iiutton,  George  -Mien 35 


-4° 


THE    HOSPITAL    BULLETIN 


Improved    Treatment    of    Tubercular    Bone 

Abscesses 

'  Improvements  and  Changes 

Initial  Address  to  the  Seniors  and  Juniors.  . 

In  Memoriam 

Internal  Medicine 

International  Clinics 40.   109. 

[nterurban  1  Orthopedic  Club 

[odine  in  (  Obstetrical  Practice,  The  Use  of.  . 
Italian  Superstition  with  Regard  to  Placenta. 

Items 15,  34.  55.  75-  95.   :  l5> 

[33.   [54.  173.   lS.V  214, 

Ivey.  William  P 

James.  William  D 

Jameson.  Horatio  G 99, 

Jarrett,  James  H 

J  ay,  John  <  1 

J  ennings,  C.I 

Joyce,  Joseph  C 

Junior  Medical  Officers 

Kappa  Psi 40.   173,  199, 

Keep  A-Pullin' 

Kelly,  Vernon  Francis 

Kenawy,  Najib 

Kennard,  Henry  W 

King.  Florence  V 

Kirk.  Norman  T 

Kloman,  E.  H 

Kohn.  Louis  Winfield 

Knipp,  Harry  E 

Krozer,  John  J.  R 

Lacrosse  Team 

Lamkin,  Edward  E 

Langley,  Louis  E 

Latham.  Peter  II 

Latin- American  Club 173, 

Lebret.  G.  H 39, 

Lecates.  Howard  E 158, 

1  -tgg,  Thomas  Henry 

Lend  a  Hand 

Levin.  Julius 

Llamas.  Enrique 

Love.  James  D 

i  .ove,  William  S 

Lyon.  William  C '>o. 

Lynch,  James  M 

Lynn.  Frank  Sidle 59,   117.   156, 

Lvon.  William  C 1  59, 

McCall,  Alvin 

McCarty,  I  tarry  D 

McConachie,  Alexander  D 138. 

McDaniel.  Lawrence  E 

McFaddin,  Albert  O 

McKnight,  Vernon  II 

McMillan.  Roscoe  C 98, 

McMullen,  John 

MacConnell,  John  Wilson 

Mackall.  John  Evans 

Mackenzie.  A.  R 

Maldeis.  Howard  1 79,   138, 

Marett.  Wm.  C... 


PAGE 
88 

14s 
90 

1  So 
i?> 
197 

:5r 

3° 

2  3° 

I  _':  I 

95 

115 

[58 

138 

97 

97 

173 

235 

1 3-' 

19 

216 

196 

75 

75 

15 

16 

159 

135 
36 
t6 

9  I 

20 

198 

218 

i.,x 

i57 
18: 
20 
234 
230 

133 

97 

[6 

218 

23 1 

2  ^- 

99 

230 

[S8 
195 

35 

i37 

t3« 
16 

38 

23-' 

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32 


PAGE 
235 

23i 

57 

220 

1 98 

35 
12 

135 

70 
230 
199 

186 

150 
32 
38 

155 
16 

119 


Marriages 19.  60.  79.  08.   ng. 

139,  159,  j  78.  199,  218. 

Martin.  Andreas 15.   118, 

Massenburg.  George  Y 

Massenburg,  Richard  C 

Matthews.  A.  A 

Matthews,   lames  G 

Matthews,  t.  A 

Mans.  Louis  M 

Mayhew.  Walter  H 

Medical  Alumni  Association 

Medical  Schools.  The  New  Rating  of  the.  .  . 
Medical  Society,  Charles  W.  Mitchell..  .  .39. 
Medicine,  The  Aims  of  Clinical  Teaching  in . 

a  leierhof .  Edward  L 

Messmore,  Harry  Benj 

Messmore.  John  Lindsey 

Michel.  William 

Miller.  Frank  O 

Minnis.  Rosamond 

Miscarriage,    A    Case   of    Six   Month-'.    In- 
duced   by    Measles    and    Complicated    by 

Tuberculosis 105 

Misseldine.  John  G 58 

Missing  Alumni 15 

Mitchell.  Charles  W 228 

Mitchell.  Mary  D 219 

Moorman.  John  A 120 

Murphy.  Franklin  D 21S 

Murray.  Thomas  J .' .    119 

Muscey,  James  S.  Lovell 19 

Mustelus  Canis.  Study  of  the  Synchronous 

Heart  Heat  and  Respiration  in  the 82 

Myers.  Z.  C 97 

Newhouse,  Benjamin 133 

Nichols.  Elijah  E 178 

Norton.  John  C 199 

Nu  Sigma  Nu 19,  40.   178.   199,  235 

1  obstetrical  Practice,  The  Use  of  Iodine  in. .    151 

<  O'Donovan,  Charles 95 

Ohle.  Henry  C 97 

<  Oldest  Alumnus  Dies 80 

(  Opening  of  the  Session  1012-13 152 

Operation.  Preparation  of  Patient  for 225 

Overman.  Charles  Augustus 16 

(  hvens,  Maurice  E.  B 1  y » 

<  'wings.  Thomas  B 16,   118 

Palmer.  J.  Denham 1  ~~ ) 

Paralysis.  Infantile.  A  Probable  Case  of.  in 

Ancient  Egypt 102 

Parramore.  James  B 174 

Pathological  Endowment  Fund..  1 3.  33,   53, 
71.  92,    112.   132.    152.   153,   171.   104.  215.  220 

Patterson.  E.  C 58 

Patrick,  George  R 120 

Patrick.  Robert  B 198 

Pearce.  William  H 236 

Pellagra  . 46,  252 

Penning.  <  lliver  Parker 210 

Pennington,  John  1 157.   196 

Feters.  Don 198 


THE    HOSPITAL    BULLETIN 


-4' 


P  \GE 

Phi  Sigma  Kappa \<>.  40,  [98 

Physiology,  Manual  of   Practical [54 

Physiology,  Technical  and  Scientific  Qualifi- 

catii  his  of  a  Teacher  <>t 51 

Pituitar)   Body  and  Its  Disorders no 

Piggott,  J.  Burr 52 

Plac<  nta,  Italian  Superstition  with  Regard  to.  30 

Pneumococcus  in  Surgery >)4 

Powell,  John  F 20 

I  'radical    Anatomy [40 

Practical  Experience  with  Spinal  Anesthesia.  21 

Preparation  of  Patient  for  <  Iperation 22$ 

Preventive  Medicine  Among  (  lur  Youth.  ...  31 

Trice.   Marshall   L 50,  1 39 

Pride,  Robert  J 236 

Prof.    Julian    J.    Chisolm    and    .Miss    Helen 

Keller 131 

Provost,  The  Late 90,  92 

Provost,  The  New,  Thomas  Fell 117.  -'14 

Provost,  The  New.  and  I  lis  Predecessors.  .  .  229 
Public    Should    Be    Educated    in    Regard   to 

Cancer  the   Same   As    Is    Being   Done   in 

Tuberculosis 1 

Queen,  William  Gwynn 151 

Quillen,  Emile  Bonniwell 159 

Randolph  Winslow  Surgical  Society.  ...  17, 

39.  [73>  [9'J 

Rankin.  Watson  S 1 13 

Raphel,  Eugene [98 

Reasonable  and  Pleasurable 14') 

Remarks  at  the  Annual  Reunion  of  the  Medi- 
cal Alumni  Association.  June  I,  1912 69 

Renovation  of  University  Buildings 156 

Report  of  a  Case  of  Abiotrophic  Cortial  De- 
generation with  Section  of  Posterior  Spinal 

Roots  for  Relief  of  Symptoms 28 

Report  of  Case 103 

Repi  irt  1  if  1'  >ur  Unusual  Cases 20  > 

Result  of  State  Hoard  Examinations 117 

Retn  ispect  and  Prospect 1  ^ 

Rich.H.  R 39 

Richards,  Granville  II 70 

Riely.  Compton 16 

Rivers,  Dwight  Cray 159 

Ri  iberts,  Charles  \Y nq 

Robertson,  J.  Righton 18 

Robinson,  Austin  E 137 

Ri  ibinsi  m.  William  K 140 

Rodman,  William  1 27 

Rosenburg,   Herbert  J 178 

Rowe,  William  T 155 

Rytina,  Anton  G 57 

Satterthwaite,  Thomas  E.,  Letter  from 172 

Sawaya,   lurgi  E 117 

Seci  ni'l  Call  for  Dinner 13 

Securing  Funds 171 

Sellman.  Wallace 15(1.  217 

Senior  Class  (  Ifneers 170 

Se]  ii  ic  S<  ire  Throat 1 08 

Settle.  George  M 156 

Shipley,  A.  M 5(1.  173 


PAGE 

Shock,  First  Aid  to  the  Injured  with  Special 

Reference  to 204 

Shock,  Symptoms  and  Treatment  of 211 

Slade.   I  tarry  M 58 

Smoker,  Annual.    Adjunct   Faculty ^7,     94 

Smoker,  Annual.  General   Alumni  Associa- 
tion  57,     77 

Smoker  by  (  linical   Assistants 198 

Smink,  C.  C to 

Smith.  C.  Urban 138 

Smith,  Edward  S 1 16 

Smith,  ( iilbert  T 117 

Smith.  Joseph  T 131) 

Smith,  Dr.  J.  1  [olmes,  Sr 117.   15.; 

Smith.  Dr.  J.   I  [olmes,  Jr 22^ 

Smith,  Maude  F 178 

Snuffer,  Dempsey  William 16,  155 

Some  Facts  Dealing  with  the  Development  of 

Aseptic  Surgery 65 

Some    Points  of   Interest   As    Regards    Long 

Bone  Fractures 164 

Some  Recent  Tube  Cases 221 

Sophomore  Class  (  (fficers 15; 

Spinal  Anesthesia.  I 'radical  Anesthesia  with.     2t 

Spruill,  St.  Clair 139 

Staff.  Maternity  Hospital 136 

Stallworth,  Claude  J 119 

Status  Quo 17: 

Steam  Roller  and  the  Medical  Colleges ()2 

Steiner,   May   K [59 

Steiner,  Ralph 119 

Steuart.  Ceo.  H 12 

Stewart.  Napoleon  Bryan to 

Stc  ikes,  William  R 117 

Stotlemyer,  C.  1 15 

Study  of  the   Synchronous  Heart  Beat  and 

Respiration  in  the  Muslelus  Canis 82 

Sullivan,  Mary  C 97 

Summer  Cruise  on  the  Spanish  Main.  .  .  121, 

141.    I'M.   181 
Surgery.  A.  septic.  Some  Facts  Dealing  with 

the  Development  of 6^ 

Surgery,    Development    of    Antiseptic    and 

Aseptic 209 

Surgical  Society,  Randolph  Winslow.  ...  17, 

39,    199 
Symptomatology  of  Typhoid   Fever  and   Its 

Complications 10 

Symptoms  and  Treatment  of  Shock 21 1 

Syphilis,  I  Jiagnosis  of 208 

Syphilis,   Is   It  Hereditary 4 

Tarun,  William 1  to,  216 

Taylor,   Emmett  <  )'Brien 217 

Technic  of   Resection   of   Rib    Under  Local 

Anesthesia 74 

Technical  and  Scientific  Qualifications  of  a 

Teacher  of  Physiology 51 

Terra  Marie 39,  218 

Terry,  William  C 230 

Tews,  Gertrude  Hedwig 218 

Thayer,  Abel  Huston 139 


„       /4*V*££ 


THE    HOSPITAL    BULLETIN 


Theater  Benefit 

The  Pathological  Endowment  Fund 

Throat,  Septic  Sore 108,  155, 

Tiffany,  Louis  McL 

Tobey,  Nathan  D 

Training  School  for  Nurses 


Address  to  the  Graduates  of 

Alumnae  of 

Commencement  of 

Treatment  of  Aneurisms  of  the  Arch  of  the 
Aorta  and  of  the  Innominate  Artery  by 
the  Introduction  of  Foreign  Bodies  Into 
the  Sac 

Tube  Cases,  Some  Recent 

Tubercular  Bone  Abscesses,  Improved  Treat- 
ment of 

Tucker,  Henry  McKee 

Tullidge,  E.   K 

Turner,  John 

Tuttle.  Arnold  D 

Typhoid  Fever  and  Its  Complications, 
Symptomatology  . 

Ulcer,  Gastric 

Undergraduate  Notes 18.  39,   198.  217, 

Underbill,  A.  J 

University  Hospital  Appointments 

University  Hospital  Staff 

University  Loses  Her  Provost 

University  of  Maryland  Medical  Society.  .  . . 

Vacation  Times 

Valentine.  A.  "W 

Van  Poole,  ( rideon  M 

Vega.  ( ierardo 

Vinup,  Fred 


■AGE 

18 
132 

196 

20 

58 
61 

232 

57 


124 

221 

88 

38 

198 

137 

10 
128 
234 

15 

75 

117 

91 
39 

1 12 

15 
156 

107 
230 


PAGE 

Visitors  to  Hospital 155 

Visitors  to  University  Hospital 177 

Walton,  Henry  R 120 

Ward  at  Hospital,  B.  &  0 174 

Warren,  Robert  Alex 35 

Waters,  Charles  A 135 

Wegge,  William  F 196 

We   Have   Piped  Unto   You  and   Ye   Have 

Not  Danced 53 

Weiner,  Hvman  R 58,   159 

West.  M.  B 58 

Whichard,  Murray  P 197 

Whims,  Thomas  Gay ~~j 

Who  Shall  It  Be.  ..' 92 

Williams,  C.  B '39 

Williams.  J.  Whitridge 137 

Wilson,  Gordon 138 

Wilson,  Luther  B 96,  197 

Winchester.  Benjamin  T 219 

Winslow,  FitzRandolph 156 

Winslow,  John  R 109.   137 

Winslow.  Nathan 133,   108 

Winslow.  Randolph 15.   7,2,  95,   174.    [98 

Woodruff,  Charles  S 137 

Woods,  Dr.  Hiram,  In  Honor  of jo 

Wooton,  William  T 15S 

Worthington,  Thomas  Chew I35 

Wright.  Ann  Chapman 19 

Wright,  Eugene  Bascom 58.  105.  135 

Wright,  Josephus  A 1 18.  174 

Young,  Calvin  T 155 

Young,  George 07 

Yourtree,  George  W 159 

Zueblin,  Ernest 96,   Tit.   153.   155